SPECIAL ACCOUNTS REPRESENTATIVE III - ANESTHESIA - FULL TIME

Watson-Clinic; Lakeland (FL); On-site; USD 42,000 - 60,000; Full time

Job summary

Watson-Clinic in Lakeland, FL is seeking an Insurance Claims Examiner to follow up on open claims and ensure compliance with billing guidelines.

You will review claims, handle disputes and appeals with carriers, and document actions in the billing system. The role requires accuracy, strong organization, and knowledge of CPT/ICD-10 coding.

A background in medical office billing and proficiency with payer portals will help you succeed in this on-site position.

Qualifications

• 3–6 years in a medical business office or related field.
• Experience with claims adjudication for multiple payers.
• Current CPT and ICD-10 coding knowledge.

Responsibilities

• Follow up on open claims per guidelines and review for completeness.
• Resolve disputes and appeals of third-party denials; contest unpaid charges.
• Enter insurance information and stay current on FSCs.
• Assist in education of new employees and monitor workflow in the Insurance Department.

Skills

Claims adjudication

Billing guidelines

Medical terminology

Typing 40 wpm

Windows applications

Education

High School diploma

Tools

Payer portals

Job description

Description

Essential Functions

• Follows up on open claims in accordance with established guidelines. Reviews claims for completeness and compliance with billing guidelines.
• Works to resolution disputes and appeals of third-party denials. Contests charges that are not paid or underpaid with the carrier. Accesses available third party and governmental on-line services. Documents all actions within the system.
• Possesses a comprehensive understanding of Clinic contracts, carrier specific, State or Federal governmental, HCFA, or CPT billing and reimbursement guidelines. Reviews bulletins, updates, etc., and maintains as reference/ resource material.
• Possesses a comprehensive understanding of how to enter insurance information into the billing system. Remain current on new FSC's that are created and understand how they are used. Reviews and edits registration information according to clinic policy.
• Cross train in all areas within the Insurance Department. Assist Supervisor in the education of new employees, the monitoring of workflow in all areas of claims processing and payment posting within the Insurance Department.
• Accesses available third-party and government on-line services. Accesses appropriate websites to obtain current carrier guidelines, verify eligibility and re-files claims if necessary.
• Acts as liaison to the department to ensure any special projects and requests are completed efficiently and correctly. Acts as resource to peers.
• Completes all appeals according to payer specific guidelines. Reviews clinical documentation for appeals and composes detailed formal appeal letters for payment.

Requirements

Required Education and Experience

High School graduate or equivalent. 3-6 years in a medical business office or related field. Experience with the claims adjudication process for multiple governmental agencies and private insurance carriers. Basic medical terminology. Current CPT and ICD-10 coding experience.

Additional Eligibility Qualifications

Ability to assist new hires and others in detailed training processes. An aptitude to retain detailed information. Ability to be multi-tasked oriented, to prioritize and to produce an acceptable volume of work. Excellent organizational and problem-solving skills. Excellent communication skills, oral and written. Basic knowledge of Windows-base computer applications. Accurate typing rate of 40 wpm. Ability to operate the following equipment: computer, copier, fax, web based payer sites, and 10-key calculator.