SPECIAL ACCOUNTS REPRESENTATIVE II - INSURANCE FOLLOW UP - FULL TIME

WATSON CLINIC LLP•Baltimore, MD

8d•Onsite

About The Position

This is a full-time role for a Special Accounts Representative II focusing on insurance follow-up. The primary responsibilities include following up on open claims, reviewing them for completeness and compliance, resolving disputes with third-party denials, and contesting underpaid or unpaid charges with carriers. The role requires accessing various online services, documenting actions in the system, and maintaining a comprehensive understanding of clinic contracts, billing guidelines, and reimbursement policies. Additionally, the position involves entering insurance information into the billing system, staying updated on new FSCs, and editing registration information. A key aspect of this role is cross-training in all areas of the Insurance Department, assisting with new employee education, and monitoring staff and workflow in claims processing and payment posting.

Requirements

High School graduate or equivalent.
2-4 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.
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.

Responsibilities

Follows up on open claims in accordance with established guidelines.
Reviews claims for completeness and compliance with billing guidelines.
Works to resolution disputes 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.
Maintains 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.
Enters insurance information into the billing system.
Remains current on new FSC’s that are created and understands how they are used.
Reviews and edits registration information according to clinic policy.
Cross trains in all areas within the Insurance Department.
Assists Supervisor in the education of new employees, the monitoring of staff and workflow in all areas of claims processing and payment posting within the Insurance Department.
Accesses appropriate websites to obtain current carrier guidelines, verify eligibility and re-files claims if necessary.