- The Billing & Follow-Up Representative reviews, researches, and processes claims in accordance with contracts and policies to determine the extent of liability and entitlement, as well as to adjudicate claims as appropriate.
Required skills & experience (the “must haves” to be considered)
1. Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-9/ICD-10, UB92, CPT, HCPCS), and basic computer skills are highly desirable
2. High school diploma or an equivalent combination of education and experience.
3. Associate degree in accounting or business administration high desired.
4. Data entry skills (50-60 keystrokes per minutes).
5. Past work experience of at least one year within a hospital or clinic environment, an insurance company, managed care organization, performing medical claims processing, financial counseling, financial clearance and/or customer service activities is required.
6. Knowledge of insurance and governmental programs, regulations and billing processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is required.
What you need to know
– Coding and processing claim forms
– Reviewing claims for complete information, correcting and completing forms as needed
– Accessing information and translating data into information acceptable to the claims processing system
– Preparing claims for return to provider/subscriber if additional information in needed.