Insurance Claims Representative - Full Time

IRMC • Indiana, PA

9h

About The Position

In this role you will be: Preparing and submitting electronic submission of claims transmission daily. Preparing and submitting non-electronic submission of claims transmission daily. Processing verification of transmitted claims and their accuracy on the electronic billing system. Processing and assisting in preparing appropriate documents such as spreadsheets for cost reporting purposes. Requesting accurate adjustments with supporting documentation and refunds to insurance carriers and patients. Submitting claims to secondary payers. Responding to insurance carrier requests and patient inquiries when needed. Processing accurate charge correction and claim adjustments as well as reports/duties assigned. Able to appropriately identify and update claims in the hospital system. Communicating using electronic media to multiple entities. Communicating with other departments to ensure correct and accurate billing processes. Participating in training and development on the processes and related industry knowledge required to perform with a high degree of accuracy and timeliness. Maintaining all updates related to performing the job functions with comprehensive information for any changes on industry regulations and payer requirements associated with the function. Ensuring a high degree of customer service in the interaction with both direct and indirect customers in the completion of the functions. Responsible for managing processes established for the identification, communication, and collection of patient liable balances and referring cases for financial counseling as appropriate. Monitoring outcomes for compliance with process and policy and customer service so to provide periodic feedback for reinforcement of compliance and corrective action for deficiencies. Identifying process deficiencies or improvements and making recommendations to the insurance claims supervisor. Participating in meetings and other methods of communication needed to determine root causes of issues and recommending corrective actions to the insurance claims supervisor. Performing system testing of updates and releases within the functional scope as assigned. Performing system configuration and table maintenance of the assigned systems. Knowledgeable of insurance billing and regulations to produce compliant data to insurance carriers, employers, and patients. OTHER DUTIES Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Requirements

• EDUCATION: High school diploma
• EXPERIENCE: - 3 years clerical experience preferred - Experience with computers required - 6 months experience with hospital insurance billing preferred

Nice To Haves

• LICENSURE/CERTIFICATION: AAHAM certification after 1 year preferred

Responsibilities

• Preparing and submitting electronic submission of claims transmission daily.
• Preparing and submitting non-electronic submission of claims transmission daily.
• Processing verification of transmitted claims and their accuracy on the electronic billing system.
• Processing and assisting in preparing appropriate documents such as spreadsheets for cost reporting purposes.
• Requesting accurate adjustments with supporting documentation and refunds to insurance carriers and patients.
• Submitting claims to secondary payers.
• Responding to insurance carrier requests and patient inquiries when needed.
• Processing accurate charge correction and claim adjustments as well as reports/duties assigned.
• Able to appropriately identify and update claims in the hospital system.
• Communicating using electronic media to multiple entities.
• Communicating with other departments to ensure correct and accurate billing processes.
• Participating in training and development on the processes and related industry knowledge required to perform with a high degree of accuracy and timeliness.
• Maintaining all updates related to performing the job functions with comprehensive information for any changes on industry regulations and payer requirements associated with the function.
• Ensuring a high degree of customer service in the interaction with both direct and indirect customers in the completion of the functions.
• Responsible for managing processes established for the identification, communication, and collection of patient liable balances and referring cases for financial counseling as appropriate.
• Monitoring outcomes for compliance with process and policy and customer service so to provide periodic feedback for reinforcement of compliance and corrective action for deficiencies.
• Identifying process deficiencies or improvements and making recommendations to the insurance claims supervisor.
• Participating in meetings and other methods of communication needed to determine root causes of issues and recommending corrective actions to the insurance claims supervisor.
• Performing system testing of updates and releases within the functional scope as assigned.
• Performing system configuration and table maintenance of the assigned systems.
• Knowledgeable of insurance billing and regulations to produce compliant data to insurance carriers, employers, and patients.

What This Job Offers

• Job Type: Full-time
• Education Level: High school or GED