Insurance Representative

Carolina-Asthma-and-Allergy-Center-Maste; Charlotte (NC); On-site; USD 38,000 - 52,000; Full time

Job summary

Carolina-Asthma-and-Allergy-Center-Maste is seeking a claims processing professional to ensure timely processing of claims and payments. Responsibilities include weekly review of edits, correcting CPT/ICD data, and handling denial work in Navicure.

You will follow up on aged charges, assist patients and providers, and resolve billing disputes. The role requires a Bachelor's degree in health or business administration and at least two years of claims experience, with strong knowledge of medical

Qualifications

• Bachelor's degree in health or business administration.
• Minimum two years of experience in claims processing in a health care setting.
• Knowledge of health care insurance claim practices and compliance.
• Proficient with computer systems and medical terminology.

Responsibilities

• Weekly review of claim edits reports and corrects the claim information such as CPTs, valid ICD-10's, referring doctor name/UPIN #, modifiers, etc.
• Work and corrects claim rejections from Navicure, correcting necessary data.
• Daily follow-up of aged and denied charges.
• Handle patient and provider calls in reference to claims or statements.
• Identifies and resolves patient billing complaints.
• Performs various collection actions including contacting patients by phone, correcting, and resubmitting claims to third party payers.
• Identify and correct posting errors and overpayments.

Skills

Claim information gathering

Troubleshooting claim issues

Written and verbal communication

Education

Bachelor's degree in health or business administration

Tools

Navicure

Job description

General Summary: A nonexempt position responsible for the proper and timely processing of claims and payments to providers.Essential Job Responsibilities:Weekly review of claim edits reports and corrects the claim information such as (CPTs, valid ICD-10's, referring doctor name/UPIN #, modifiers, etc.).Work and corrects claim rejections from Navicure, correcting necessary data.Daily follow-up of aged and denied charges.Keep A/R Supervisor informed on all Payer problems.Contacting insurance carriers via phone or website.Handle patient and provider calls in reference to claims or statements.Answer and forward incoming calls in a timely manner.Identifies and resolves patient billing complaints.Performs various collection actions including contacting patients by phone, correcting, and resubmitting claims to third party payers.Identify and correct posting errors and overpayments.Review and correct COB errors.Other duties and projects as assigned.Occasional overtime may be required.Education: Bachelor's degree in health or business administration.Experience: Minimum two years of experience in claims processing in a health care setting.Other Requirements: NonePerformance Requirements:Knowledge:Knowledge of clinic policies and procedures.Knowledge of health care insurance claim practices and compliance.Knowledge of computer systems, programs, and applications.Knowledge of medical terminology.Skills:Skill in gathering and reporting claim information.Skill in trouble-shooting claim insurance problems.Skill in written and verbal communication and customer relations.Abilities:Ability to work effectively with physicians, other medical staff, and external agencies.Ability to identify and analyze claim problems.Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work.Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking or standing the remainder.