Medical Claims Review Representative

Medical Claims Review Representative

To ensure that all charges, claims and / or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and self-pay patients.

Essential Duties And Responsibilities :

• Review claims submissions for accuracy by confirming proper payer, authorizations, referrals and all other key billing components.
• Follow claims from submission to payment using EMR analytics, reports, payer portals and other resources as necessary.
• Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner.
• Review payer EOBs for a complete understanding of payments and assignment to patient responsibility.
• Use your knowledge of health insurance claim processing, patient policies by payer and payer plan dynamics for commercial, governmental, worker's compensation, labor funds and others to assess accuracy of payments.
• Work diligently to resolve denied / rejected claims by researching and determining the causes of the unpaid claims and making every effort to resolve the denial / rejection in order to promptly resubmit to the payer.
• Respond to patient and / or insurer inquiries in a professional, timely efficient and knowledgeable fashion, ensuring HIPAA and MOC guidelines are followed.
• Other job tasks as necessary

Competencies :

Education And Experience Required :

Working Conditions / Physical Demands :