Claims Representative

Company: MedData
Location: Draper
Posted on: June 7, 2021

Job Description:

MedData has an excellent career opportunity available as an Appeals & Denials Claims Rep to work in our Draper, UT office. The schedule for this full time role is Monday- Friday 7:30am -4pm.

**We are looking for individuals that have great customer service skills, detailed, a knack for problem solving, a sense of urgency and excellent communication skills.

POSITION OVERVIEW:

The purpose of this position is to assist hospitals and providers in resolving accounts that are denied and need information from the patient who has been unresponsive to the hospital/providers attempts to secure the needed information. Specifically, this position is focused on the effort to obtain the necessary forms, documents, responses from the patient, hospital, employer and from other sources (including telephone, mail, email and fax), resubmission of insurance bills and appeals to insurance carriers. Unresponsive Patient Denial Claims Specialists facilitate patients and insurances to ensure proper claim processing for resolution.

ESSENTIAL JOB FUNCTIONS:

+ Maintain a queue of Unresponsive Patient Denial accounts as assigned by management

+ Maintain quality and productivity levels set by management, once full job proficiency has been achieved.

+ Contact patient's employer, insurance carriers and patient via telephone and mail to obtain required information for denied claims.

+ Review and research insurance carriers to determine accurate payer order

+ Ensure that patients properly update necessary information according to payer and project specific guidelines

+ Investigate and work with patients to correctly update necessary information and documentation with their insurance carriers

+ Support patients by answering any questions about the insurance process related to their account.

+ Coordinates with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.

+ Requests appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition.

+ Perform manual data entry of patient accounts and/or claim forms

+ Resubmit hospital and physician bills to insurance companies for payment.

+ Maintain contact with insurance adjusters/carriers, employers and patients during the claim adjudication process to ensure that the hospital and physician bills are paid timely and in full.

+ Responsible for obtaining claim status and gathering supporting documentation to submit appeals

+ Provide strong customer service to clients and provide responses to client inquiries within 24 hours.

+ Provide detailed updates to MedData's account management system and hospital/provider practice management system as account work is completed.

+ Assist in training both new and existing employees, which may include contributing specific training material.

+ Escalate complex, complicated or challenging accounts to management to ensure accounts are progressing effectively.

+ Identify and discuss root cause issues with management.

+ Maintains and updates proper account documents in multiple systems.

+ Assist management with adhoc inventory initiatives and other projects, as needed

+ Makes written or verbal appeals to payers on denied claims.

QUALIFICATIONS:

+ High School Diploma or GED, some college coursework preferred

+ Ability to communicate effectively verbally and in writing and be able to speak professionally with patients and insurance companies

+ Proven ability to be assertive in order to critical think and proactively resolve issues

+ Demonstrate ability to organize and set priorities according to situation all demands

+ Excellent customer service skills

+ Must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, understand how to navigate through web-based applications, and the ability to learn in-house computer applications

+ Positive team player attitude and mindset

+ 0-1 years of related experience in the field or in a related area

BENEFITS:

MedData believes in making a positive impact not only within our industry but also with our employees -the organization's greatest asset. We take pride in offering comprehensive benefits in a vast array of plans that contribute to the present and future well-being of our employees and their families.

Just some of the benefits we offer:

+ Medical, Dental & Vision Insurance

+ HSA, FSA

+ 401K

+ Paid Time Off: Up to 3 weeks first year PTO plus 7 paid Holidays

+ Employee referral bonus program

+ Teamwork: We believe in teamwork and having fun together

+ Career Growth: Gain great experience to promote to higher roles

PHYSICAL DEMANDS

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.

The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.

This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.

To join our team of 2,000 employees and growing, please apply directly to this posting.

MedData is an Equal Opportunity Employer

ID: 2021-6564

External Company URL: www.cardonoutreach.com

Street: 132 E 14075 S

Keywords: MedData, Draper , Claims Representative, Other , Draper, Utah