Claims Research Specialist ll at West Florida… · Pensacola

JOB SUMMARY

Under the direction of the MedPro Claims Research Supervisor, the Claims Research Specialist II is responsible for performing the duties related to insurance follow up/collection and maintaining of accounts receivables.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ability to work with major carriers (i.e. BCBS of FL, Medicare, Medicaid, etc.) accurately and efficiently.
• Familiarity with and ability to work all carriers with the exception of “Special Accounts” (i.e. WC, MVA, etc.).
• Work weekly claims worklist: Carrier specific worklist daily, No activity, Client Respond (Goal: 48 hours)
• Work insurance requests.
• Work correspondence.
• Work rebilled HCFA claim forms.
• Respond to questions from billing staff related to insurance or account A/R activity in a courteous and professional manner.
• Communicate with Claims Research Supervisor on carrier trends
• Perform error corrections.
• Ability to effectively communicate via claim notes per MedPro policy and procedure.
• Update patient accounts with the correct insurance information.
• Refile coding denials with appropriate material received from the Consultant Practice Manager (CPM) and/or coders.
• Complete assigned projects within deadlines, as directed by the Claims Research Supervisor.
• Perform daily functions with minimum guidance from Claims Research Supervisor.
• Other duties as assigned.

CORPORATE CULTURE RESPONSIBILITIES

• Follow established corporate and department-specific policies and procedures.
• Attend all corporate and department-specific required training.
• Uphold MCC’s Purpose, Values, and Vision.
• Abide by MCC’s Corporate Culture Responsibilities.
• Perform other duties as may be assigned cheerfully and willingly.

EDUCATION/EXPERIENCE REQUIREMENTS

• Minimum education requirement is high school diploma, or equivalent.
• Minimum 1-year insurance billing experience or equivalent, and minimum 1-year medical billing software or equivalent.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to prioritize and manage multiple tasks.
• Displays customer services skills, strong interpersonal skills, close attention to detail, excellent verbal and written communication skills, and basic math skills.
• Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers.
• Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner.
• Displays computer proficiency (i.e. PC Windows, MS Office) and ability to quickly learn new applications.
• Acceptable typing speed and accuracy with ten-key by touch skills.
• Proficient in use of English language both in written and verbal communication.
• Must be able to communicate with individuals of varying socio-economic backgrounds.
• Must be committed to the protection of confidential information, records and/or reports.
• Possess strong critical thinking and analytical skills.

PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
• Standing/Walking: Occasionally; activity exists up to 1/3 of the time
• Keyboarding/Dexterity: Frequently; activity exists from ¾ of the time
• Ability to look at a computer screen for extended periods.
• Ability to perform constant repetitive hands and finger motions.
• Ability to maintain focus while working in close proximity to others.
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes

EMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Must exhibit stable work behaviors daily.
• Must possess adequate individual coping skills.
• Ability to remain calm and professional regardless of workload or time constraints.
• Must be able to work under stress and remain calm and professional.

WORK ENVIRONMENT

• Office environment.
• Exposed to frequent and constant interruptions in daily functions/schedule.
• May be required to work extended hours to meet department needs.