SPECIAL ACCOUNTS REPRESENTATIVE III - ANESTHESIA - FULL TIME

Watson Clinic; Lakeland (FL); On-site; USD 40,000 - 56,000; Full time

Job summary

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

You will dispute third-party denials, navigate online payer portals, and document actions in the system while upholding CPT/ICD-10 coding standards and clinic policies.

Qualifications

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

Responsibilities

• Follows up on open claims per guidelines and reviews for completeness and compliance.
• Works to resolve disputes and appeals of third-party denials; contests underpaid charges with carriers.
• Maintains knowledge of contract, payer guidelines, and CPT/HCFA guidelines; references bulletins and updates.
• Enters insurance information into the billing system and stays current on FSCs and registration edits according to policy.
• Cross trains in Insurance Department, assists Supervisors with training and workflow monitoring.
• Accesses payer portals to verify guidelines and re-file claims as needed.
• Acts as liaison to ensure special projects are completed efficiently and correctly; provides peer support.
• Completes appeals per payer guidelines; reviews clinical documentation and writes formal appeal letters.

Skills

Medical billing

Claims adjudication

CPT/ICD-10 coding

Documentation

Communication

Education

High School diploma or equivalent

Tools

10-key calculator

Windows-based software

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.