A/R Insurance Claim Representative

Job Details
Level
Experienced
Job Location
MSO OADC Poughkeepsie (1900) - Poughkeepsie, NY
Position Type
Full Time
Education Level
High School or Equivalent
Salary Range
$16.05 - $19.90 Hourly
Travel Percentage
None
Job Shift
Day
Job Category
Health Care
Description
Who we are:
Spire Orthopedic Partners is a growing national partnership of orthopedic practices that provides the support, capital and operational resources physicians need to grow thriving practices for the future. As a Management Services Organization (MSO), Spire provides the infrastructure for administrative operations that allows practices to operate at their highest level, so doctors can focus their efforts on what matters most - patient care. Rooted in the 100-plus-year legacy of its founding partners, the network spans the Northeast with 128 physicians, over 1100 employees, and 28 locations from Connecticut, New York, and Massachusetts
At Orthopedic Associates of Dutchess County we believe our employees are our greatest asset. We believe in hiring the best people and cultivating a winning team. Investing in our employees' future success is investing in our future success. We hire both experienced medical staff as well as those just starting out in the field looking for an opportunity to learn a profession. We promote from within whenever possible because we know our staff are highly trained and guided towards success!
What you'll do:
The Accounts Receivable Claim Representative is responsible for ensuring accuracy of claims submitted by performing follow-up on aged accounts, verifying accuracy of patient demographic data, processing account adjustments, reviewing payment to ensure payment amounts are in accordance with contracted and applicable rates, contacting and responding to patient calls and verifying and correcting insurance coverage when necessary. The scope of responsibility includes but is not limited to having the ability to follow departmental policies and protocols, monitor and review changes and policies of insurance companies, properly notify Director of Operations as well as other Billing Department staff members of said changes and perform other tasks as deemed necessary. The Accounts Receivable Insurance Claims Representative is classified as a nonexempt employee and is eligible to overtime pay with prior approval and in accordance with the practice's personnel policies.
Responsibilities/Duties:

• Review, correct and provide detail follow up on claims in PM according to assigned insurances and "buckets".
• Generate monthly aging reports from PM System according to assigned insurance. Aged reports will be worked within an assigned one-month time frame
• Provide proper follow-up of nonpaid claims which includes, but is not limited to:
• Review of Explanation of Benefits for claim rejection reasons
• Review of all billing data information for accuracy
• Verification of insurance coverage
• Resubmitting/dropping claim after correction of insurance or demographic data
• Submitting first, second and third level appeals on inappropriately denied claims
• Generate and review necessary reports in PM system on a weekly basis according to assigned insurance.
• Determine denial reason and appeal with carrier or adjust if payment is appropriate
• Generate and review AR report in PM system on a monthly basis
• Respond to telephone requests from patients or insurance companies
• Monitor and review changes in policies and claim submission requirements
• Documentation of changes, corrections or appeals in practice management system
• Maintain a professional work atmosphere by behaving and communicating in a manner that gets along with patients, physicians, coworkers, and administration
• Any and all other duties as assigned by the billing manager

Qualifications
Who you are:
Qualifications:

• Minimum of 1-year previous Medical Billing experience
• Working knowledge of HCPC's, ICD-10 and CPT medical coding
• Knowledge of Insurance reimbursement guidelines
• Polite telephone etiquette and good communication skills (written and oral)
• Computer literacy skills preferred, including practice management software, EMR, Microsoft Word and Excel.
• Detail Oriented and strong organizational skills preferred
• High School Diploma or equivalent; required

What we offer:

• Excellent growth and advancement opportunities
• Dynamic environment
• Access to a diverse network of practitioners
• Broad infrastructure of tools and programs to enhance the employee experience
• Competitive Compensation
• Generous PTO
• Benefits package: health, dental, vision, 401(k), etc.

We are an equal-opportunity employer. Qualified Applicants are considered for positions and are evaluated without regard to actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex, or gender (including pregnancy, childbirth, and related medical conditions), gender identity or gender expression (including transgender status), sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances (referred to as "protected characteristics").