Reviewing and addressing processed claims to ensure proper payments are received according to the payers' contract;Reviewing unprocessed claims within the payers' timely filing limits for resubmission of claims for payment;Researching Eligibility of Benefits (EOB) to verify correct payment and adjustments are posted to patient accounts;Researching Eligibility of Benefits (EOB) to determine if unpaid balances need to be appealed to the appropriate Workers' Compensation Committee;Researching denie... more details
The responsibilities of this job include, but are not limited to, the following:
Reviewing and addressing processed claims to ensure proper payments are received according to the payers' contract;
Reviewing unprocessed claims within the payers' timely filing limits for resubmission of claims for payment;
Researching Eligibility of Benefits (EOB) to verify correct payment and adjustments are posted to patient accounts;
Researching Eligibility of Benefits (EOB) to determine if unpaid balances need to be appealed to the appropriate Workers' Compensation Committee;
Researching denied claims or claims with no response to determine proper follow up steps be taken to obtain payment;
Correcting registrations on Workers' Compensation accounts and refiling claims;
Maintaining the daily work flow goals established for the Occupational Health Insurance Representatives;
Addressing account inquiries and/or update requests in a timely manner;
Establishing and maintaining a working relationship with payer representatives to ensure proper claim filing and reimbursement;
Effectively communicate trends or issues to the Occupational Health Operations Manager;
Keeping informed of all changes relating to Workers' Compensation laws and requirements to ensure proper claim filing and payments;
Working through accounts with outstanding balances and collecting from the responsible party;
Following departmental and corporate policies and procedures;
Responsible for the use and operation of the following equipment: telephone, copier, printer, fax, computer, billing system, Microsoft Office Suite, imaging system, and calculator.
Minimum education and professional requirements include, but are not limited to, the following:
Employee must be 18 years of age or older;
High school graduate or equivalent;
Knowledge of Workers' Compensation laws and policies;
Three years of experience working in the healthcare field, preferably in a medical billing department;
Excellent analytical, written and verbal communication skills;
Ability to prioritize, organize and multi-task in a timely manner;
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