Insurance Representative

CAROLINA ASTHMA AND ALLERGY CENTER MASTER•Charlotte, NC

7d•Onsite

About The Position

A nonexempt position responsible for the proper and timely processing of claims and payments to providers. The role handles claim edits and rejections, follows up on aged and denied charges, communicates with insurance carriers, and assists patients and providers with claim and billing questions. The position works in a well-lighted office environment and involves sitting approximately 90 percent of the day, with the remainder spent walking or standing. Occasional evening and weekend work and occasional overtime may be required.

Requirements

Bachelor's degree in health or business administration.
Minimum of two years of experience in claims processing in a health care setting.
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.
Skill in gathering and reporting claim information.
Skill in troubleshooting claim insurance problems.
Skill in written and verbal communication and customer relations.
Ability to work effectively with physicians, other medical staff, and external agencies.
Ability to identify and analyze claim problems.

Responsibilities

Review claim edit reports weekly and correct claim information, including CPTs, valid ICD-10 codes, referring doctor name and UPIN number, and modifiers.
Work and correct claim rejections from Navicure by correcting necessary data.
Follow up daily on aged and denied charges.
Keep the A/R Supervisor informed about payer problems.
Contact insurance carriers by phone or website.
Handle patient and provider calls regarding claims or statements.
Answer and forward incoming calls in a timely manner.
Identify and resolve patient billing complaints.
Perform collection actions, including contacting patients by phone and correcting and resubmitting claims to third-party payers.
Identify and correct posting errors and overpayments.
Review and correct COB errors.
Perform other duties and projects as assigned.