Purpose: The Claims Representative is responsible for reviewing delinquent accounts to ensure that the account is processing correctly, or if further collections or write-offs need to occur. The Claims Representative will help correct claim discrepancies and account discrepancies which may allow future visits to be processed correctly. The Representative regularly audits accounts to ensure they have been adjudicated by insurance and patient copays have been collected and posted.
- Reviews delinquent and bad debt accounts to ensure payment to organization and patient balance is correct. This includes, but is not limited to insurance adjudication and proper collection of patient copays.
- Generates and monitors work lists specific to the Claims role.
- Corrects claim and account discrepancies ensuring that insurance is attached correctly, aged accounts are addressed, and completing work tickets for the Central Business Office (CBO) to make needed corrections.
- Utilizes healthcare collections best practices and is able to work delinquent accounts following these industry standards.
- Researches Help Desk Tickets for further discrepancies on accounts.
- Posts received payments from business associates to correct accounts.
- Runs various reports.
- Utilizes various internal and external software systems to perform collections work.
- Escalates complex accounts and claims to management as appropriate.
- Advises practice and CBO staff regarding medical documentation needed to provide to insurance companies.
- Continuous improvement requirements up to 4 hours a week.
- Other duties and projects as assigned.
Required Skills and Experience
- High School Diploma required. Bachelor’s degree strongly preferred.
- 1-3 years revenue cycle experience required, dental (or healthcare) preferred.
This position requires that candidates embody the principles of our core values and demonstrate aptitude in the following areas:
- Professional communication skills (verbal, listening and written); Ability to tactfully present information in clear and understandable manner.
- Analytical ability; Ability to analyze contracts, interpret metrics and understand workflows.
- Detail-oriented focus; Ability to work with complex claims.
- Flexibility; Ability to adapt to change and willingness to take on new tasks.
- Proficient with technology; Ability to utilize Microsoft Office applications, databases, EHR and practice management software, as well as, internet applications.
- Time management; Ability to prioritize and efficiently process claims
- Professional integrity; Ability to work independently with a high level of professionalism, dedication and commitment.
- Results‐oriented; Ability to meet deadlines and hold vendors accountable to service level agreements.
- Interpersonal and relationship-building skills; Ability to establish and maintain positive working relationships, internally and externally.
- Process improvement-minded; Ability to be receptive and open to regular feedback as provided, to enhance and develop performance.
- Office with cubicle environment, headsets may be utilized, but not required.
- Fast-paced office environment.