Claims Service Rep (REMOTE) Job

Summary

Responsible for resolving more complex outstanding unpaid and/or unprocessed medical claims and denied claims submitted to third party payers on behalf of SPG providers.  Works closely with CBO staff to capture denial data in the interest of denial prevention and provider education.  Resolves outstanding claims by accessing third party payer web sites, making and accepting phone calls, and sending and receiving correspondence to and from third party payers and various government agencies.  Works under minimal supervision and may adapt procedures, processes, and techniques to meet the more complex requirements of the job.  Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Education/Experience/Licensure

 

Education/Formal Training

Work Experience

Credential/Licensure

 

REQUIRED:

High school graduate or equivalent.

Two years experience in billing and third party payer follow-up experience.

N/A

 

PREFERRED:

N/A

Two years experience customer service experience.

N/A

 

SUBSTITUTIONS ALLOWED:

N/A

N/A

N/A

Knowledge/Skills/Abilities

• Strong organizational and time management skills.

• Strong telephone, communication and diplomacy skills.

• Personal computer skills for the purpose of accessing information on the internet and other applications to obtain information.

Key Job Responsibilities

• Reviews more complex accounts, files appropriate claims, and provides follow-up on claims.

• Contacts patients and insurance companies to identify barriers in getting more complex claims paid.

• Routes more complex accounts back to appropriate parties after self-pay balances are determined.

• Provides research on more complex bill disputes, handles adjustments and follows up on outstanding claims.

Physical Requirements

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.

• Must have good balance and coordination.

• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.

• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.

• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work.