Medical Claims Processor

Job Summary:

The Medical Claims Processor will be responsible for managing AR follow-up for all payers and ensuring accurate documentation of account information.

Supervisory Responsibilities:

This position has no direct supervisory responsibilities.

Duties/Responsibilities:

• Perform pre-call analysis and check status by calling the payer.

• Maintain documentation on the client software to send necessary documentation to insurance companies and maintain a clear audit trail for future reference.

• Record after-call actions and perform post call analysis for the claim follow-up.

• Assess and resolve inquiries, requests, and complaints through calling to ensure that client inquiries are resolved as first point of contact.

• Provide accurate product and service information to customers, research available documentation including authorization, nursing notes, medical documentation on client's systems, interpret explanation of benefits received, etc. prior to making the call.

• Perform analysis of accounts receivable data and understand the reasons for underpayment, days in AR, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments.

• Perform other related duties as assigned.

Qualifications

Required Skills/Abilities:

• Ability to meet deadlines, handle and prioritize simultaneous requests and projects.

• Good communication skills and call center experience.

• Knowledge of denials management, AR fundamentals and prior authorization preferred.

• Strong attention to detail, demonstrated integrity and professionalism.

• Basic working knowledge of computers.

• Ability to maintain confidentiality.

• Familiarity with Microsoft Office applications and database software.

Education and Experience:

• 1-3 years of experience in accounts receivable follow-up/denial management for healthcare customers

• High school diploma or equivalent

Physical Requirements:

• Prolonged periods of sitting at a desk and working on a computer.