Midwest Orthopaedic Consultants
Medical Claims Review Representative
Midwest Orthopaedic Consultants, Orland Park, Illinois, United States, 60462
Medical Claims Review Representative
To ensure that all charges, claims and/or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and self-pay patients. Essential Duties And Responsibilities: Review claims submissions for accuracy by confirming proper payer, authorizations, referrals and all other key billing components. Follow claims from submission to payment using EMR analytics, reports, payer portals and other resources as necessary. Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner. Review payer EOBs for a complete understanding of payments and assignment to patient responsibility. Use your knowledge of health insurance claim processing, patient policies by payer and payer plan dynamics for commercial, governmental, worker's compensation, labor funds and others to assess accuracy of payments. Work diligently to resolve denied/rejected claims by researching and determining the causes of the unpaid claims and making every effort to resolve the denial/rejection in order to promptly resubmit to the payer. Respond to patient and/or insurer inquiries in a professional, timely efficient and knowledgeable fashion, ensuring HIPAA and MOC guidelines are followed. Other job tasks as necessary Competencies: Experience using EMR, EHR and other healthcare/billing related systems to include Allscripts, Mod Med, EPIC, Exscribe, Health Ipass etc., Experience with web portals such as Availity Proficiency using Microsoft Excel Thorough knowledge of medical insurance terminology and payer explanation of benefits and experience working with medical benefit plans department of labor for workers comp claims Experience with patient assistance and government programs such as Medicare and Medicaid Proficient at multitasking and managing competing priorities effectively. Effective written and oral communication. Education And Experience Required: Minimum HS diploma, college degree desired but not required Four years direct experience with core competencies Working Conditions/Physical Demands: Must be able to sit and work at a computer for extended periods of time Requires manual finger dexterity and vision corrected to normal range Must be able to lift 25 lbs
To ensure that all charges, claims and/or vouchers have been accurately submitted to the appropriate payers in a timely manner and that complete and accurate payment is received from all payers and self-pay patients. Essential Duties And Responsibilities: Review claims submissions for accuracy by confirming proper payer, authorizations, referrals and all other key billing components. Follow claims from submission to payment using EMR analytics, reports, payer portals and other resources as necessary. Partner with third party billing company personnel to resolve billing issues and support the effort of submitting clean claims with any research in a timely and responsive manner. Review payer EOBs for a complete understanding of payments and assignment to patient responsibility. Use your knowledge of health insurance claim processing, patient policies by payer and payer plan dynamics for commercial, governmental, worker's compensation, labor funds and others to assess accuracy of payments. Work diligently to resolve denied/rejected claims by researching and determining the causes of the unpaid claims and making every effort to resolve the denial/rejection in order to promptly resubmit to the payer. Respond to patient and/or insurer inquiries in a professional, timely efficient and knowledgeable fashion, ensuring HIPAA and MOC guidelines are followed. Other job tasks as necessary Competencies: Experience using EMR, EHR and other healthcare/billing related systems to include Allscripts, Mod Med, EPIC, Exscribe, Health Ipass etc., Experience with web portals such as Availity Proficiency using Microsoft Excel Thorough knowledge of medical insurance terminology and payer explanation of benefits and experience working with medical benefit plans department of labor for workers comp claims Experience with patient assistance and government programs such as Medicare and Medicaid Proficient at multitasking and managing competing priorities effectively. Effective written and oral communication. Education And Experience Required: Minimum HS diploma, college degree desired but not required Four years direct experience with core competencies Working Conditions/Physical Demands: Must be able to sit and work at a computer for extended periods of time Requires manual finger dexterity and vision corrected to normal range Must be able to lift 25 lbs