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Claims Processing Representative
Claims Processing RepresentativeBrighton Consulting Group • Coralville, IA, US
Claims Processing Representative

Claims Processing Representative

Brighton Consulting Group • Coralville, IA, US
9 days ago
Job type
  • Full-time
Job description

Job Description

Job Description

Salary :

Claims Processing Representative

Company Overview :

Supporting Iowa providers of long-term care in enhancing the quality of life for those in their service.

Our mission centers on delivering professional and technical consulting services with high standards of professionalism and integrity in our relationships with clients and others.

Position Summary

The responsibilities of BCGs Claims Processing Representative will consist of managing all aspects of claims submission and collections relating to clients health care services, client communication, and customer service.

General Job Duties :

  • All employees are responsible for a basic knowledge of the employee handbook, along with the mission and vision of the Organization, and must conduct themselves with behavior that supports these values.
  • All employees are responsible for making the most of their working time and reach maximum potential by being on time for appointments, checking voicemails / emails as appropriate and completing deadlines in a timely manner.
  • All employees are expected to escalate issues as necessary.
  • All employees must conduct themselves in a respectful and professional manner as outlined in BCGs code of ethics and conduct, as found in the policy book.
  • All employees will specifically be trained on their job duties, however; other mandatory trainings may be deemed appropriate by management for one or all members of the team.
  • All employees must occasionally collaborate with the leadership team to create, revise, and maintain accurate job descriptions.
  • All employees must maintain a 95% accuracy when submitting claims to insurance companies.
  • All employees must keep client information confidential and in accordance with HIP-PA regulations.

Essential Job Functions :

  • Manage client insurance claims by ensuring compliance with regulatory requirements, qualifications, and contracted rates.
  • Submit valid claims to a variety of insurance plans

    • Examples are, but not limited to :

    Medicare, Medicaid, Veterans Benefits, BCBS, UHC, Humana, any other enrolled insurance company

  • Monitor collections for accurate payments
  • Assure clients accounts receivable accurately reflect collectible amounts.
  • Claim Triple Check procedures and verification. Verification claims data submitted match provider medical records.

    • Part A RUGS submitted on claims match provider MDS records

  • Charges on claims match provider AP records
  • Charges and units on Part B claims match providers therapy records
  • Client education and relationship building
  • Conduct research on billing requirements with Centers of Medicare and Medicaid Services
  • Complete other projects as deemed necessary by the Claims Supervisor
  • Other projects and / or duties as assigned

    • Cross Training Requirements :

  • This position is responsible for cross training on all aspects of claims processing with other team members in the case of their absence.

    • Position Requirements :

    The requirements listed below are representative of the knowledge skills and abilities required. Employees who do not possess the requirements for a job at the time of hire will not be considered for the position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

    Required Skills and Experience :

  • Capable of working effectively independently and in a team environment
  • Must be self-motivated, goal and detail oriented
  • Flexible and adaptable to changing work environment
  • Ability to prioritize multiple tasks and manage time efficiently
  • Communicate in a positive manner with clients and escalate any issues and / or messages to the VP
  • Must be able to efficiently use Microsoft Word and Excel

    • Desired Skills and Experience :

  • Basic computer background
  • Working with insurance company representatives
  • Medical and clinical background. Working with skilled nursing facilities preferred

    • Education and Credential Requirements :

    Education :

  • An associate degree in General Education, Business Administration, or a related field is required. If an applicant does not have the required educational requirements, 2 years experience in the field is appropriate to qualify for consideration for employment.

    • Experience :

  • 2-3 years preferred, but not required.

    • Language Requirements :

    The primary language of Brighton Consulting Group is English. Excellent communication skills, as defined as the ability to :

  • Actively listen for total comprehension
  • Ask questions that enhance the understanding of a certain topic
  • Relay information and / or instruction in a descriptive and understandable fashion in both written and verbal forms

    • Mathematical Requirements :

    Basic accounting knowledge is required, as well as addition, subtraction, multiplication, and division skills to the general degree.

    Reasoning Ability Requirements :

    High-functioning, reasoning abilities are necessary to meet deadlines, prioritize company and customer needs, and work well with teammates.

    Physical Requirements :

    Occasional lifting up to 20 lbs. may be necessary from time to time. Must be able to sit for long periods of time, use fine motor skills, have the ability to view a computer monitor, and type (up to 8 hours a day). Additionally, there may be exposure to moderate noise levels due to the office functions (i.e. talking, printing, copying, etc.)

    FLSA Status :

    Non-exempt / Hourly : This position is paid an hourly rate, and therefore is eligible for 1.5 times the normal wage for every hour over 40 worked in a given work week. Overtime must be preapproved by your supervisor.

    Employment Status :

    Full time : This position at BCG require at least 40 hours a week. Occasionally, time over 40 hours may be necessary in order to meet the requirements of the position. Full time employees are eligible for all employee benefits.

    Supervision Requirements :

    This position supervises : None

    This position reports to : The Claims Supervisor

    Performance Expectations :

    All employees at Brighton will undergo annual evaluations preceding the end of each fiscal year. Below are the ten core competencies that each individual contributor (or non-supervisor) will be rated on. Additionally, there will be five metrics pulled from the Essential Job Functions that will also be scored (for a total of 15 categories). The goal of an evaluation is to help employees constructively develop their skills, review their strengths, determine opportunities of growth, and set career goals.

    Customer Focus : Able to demonstrate a high level of service delivery; do what is necessary to ensure customer satisfaction; deal with service failures and prioritize customer needs.

    Teamwork : Able to share due credit with coworkers; display enthusiasm and promote a friendly group working environment; work with other departments as necessary; support group decisions and solicit opinions from coworkers; display team spirit; never engage or start arguments in shared work areas.

    Effort : Able to be alert in a high-distraction environment; exert the appropriate amount of attention and concentration into any assigned task in one's role; maintain a high-level of productivity even while unsupervised.

    Presentation : Able to present oneself to coworkers and customers in a clean and professional manner; abide by the Company Dress Code Policy.

    Direction Acceptance : Able to receive direction from supervisors; adapt to new policies and procedures with recognition and respect; grievances and questions for authority are handled appropriately; never disrespects or challenges direction in an open environment.

    Attendance : Able to comply with regular schedule expectations; be prepared to work at the appropriate time; comply with laws and regulations on breaks and lunch times; accurately record actual time worked without falsifying information; work a minimum of 40 hours a week.

    Communication : Able to clearly relay information through the spoken or written word; read and interpret complex information; talk with customers or clients with appropriate language; listen well.

    Attention to Detail : Able to follow detailed procedures and ensure accuracy in documentation and data; do work right the first time and inspect material for flaws; carefully monitor gauges, instruments, or processes; concentrate on routine work details and organize / maintain a system of records.

    Suggestions : Ability to observe ones environment and think critically about procedure improvement; take initiative and appropriately suggest ideas to designated supervisors; contribute fresh perspective to increase productivity in individual role.

    Quality : Able to maintain high standards despite pressing deadlines; establish high standards and measures; test new methods thoroughly; reinforce excellence as a fundamental priority.

    BCG is proud to be an EEO employer. We do not discriminate based upon race, religion, color, national origin, gender, sexual orientation, gender identity, age. We strongly encourage minorities, veterans, and individuals with disabilities to apply for career opportunities at our company.

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