Healthcare Claims Representative with Cerner Experience
5 days ago
Job Purpose
The Healthcare Claims Representative is responsible for collections, account follow up, billing and allowance posting for the accounts assigned to them.
Duties and Responsibilities
Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites. Meets and maintains daily productivity/quality standards established in departmental policies. Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts. Adheres to the policies and procedures established for the client/team. Knowledge of timely filing deadlines for each designated payer. Performs research regarding payer specific billing guidelines as needed. Ability to analyze, identify and resolve issues causing payer payment delays. Ability to analyze, identify and trend claims issues to proactively reduce denials. Communicates to management any issues and/or trends identified. Initiate appeals when necessary. Ability to identify and correct medical billing errors. Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process. Understanding of under or over payments and credit balance processes. Assist with special A/R projects as needed. Analytical skills and the ability to communicate results are required. Act cooperatively and courteously with patients, visitors, co-workers, management and clients. Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards. Work independently from assigned work queues. Maintain confidentiality at all times. Maintain a professional attitude. Other duties as assigned by the management teamQualifications
Completed at least High School education At least 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR Follow ups, Denials and Appeals-outbound healthcare providers), required.Must have experience in utilizing Cerner system.Experienced on medical billing/ AR Collections.Background in calling insurance (Payer) to verify claim status and payment dispute. Must be amenable to work during US hoursMust be amenable to work onsite in Ortigas, Pasig CityWorking Conditions
Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Ability to lift heavy equipment and perform manual labor as needed Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment: The noise level in the work environment is usually minimal.
Experience these Xtraordinary benefits when you join Med-Metrix
8-Hour Shifts, Fixed Weekends OffDay 1 HMO with 2 of your dependents covered for FREEMedical Cash AllowanceRice AllowanceClothing AllowanceFree Lunch DailyPaid Time OffTraining and Staff DevelopmentEmployee Engagement ActivitiesOpportunities for Internal Mobility-
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