Medical Billing Claims Representative

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Wakefield, MA

Job status
Full time
Job description
Parallon is now hiring a Claims Representative.

As a Claims Representative you must maintain the highest level of confidentiality and comply with all HIPAA regulations and Business Associate Agreements with our clients.
Experience requirements
• 2 years of directly related industry experience.
• Must have experience in reading and understanding UB04 and HCFA forms.
• Experience in Workman’s Compensation and Motor Vehicle Claims processing.
• High energy, self-motivated and achievement oriented.
• Must have hand-eye coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment.
• Must have a normal range of hearing and eyesight to record, prepare, and communicate appropriate reports.
• Must demonstrate professionalism at all times.
• MS Office Professional (Word, Excel, and Outlook) proficiency required.
• Process claim files for payment from Workmen’s Compensation, Automobile, Property and Casualty, and Health Insurers.
• Contact Attorneys to maximize client reimbursements for services and recover all monies properly owed to our clients.
• Identify viable payer(s) and obtain all necessary documentation to properly process the claim for payment including, when applicable, IBs, UBs, Medical Records, POs, EOBs when necessary.
• Coordinate benefits with all available payers to appropriately maximize the client’s recovery while minimizing the patient’s personal responsibility.
• Review and process for payment all claims, in which adequate billing information has been obtained, to the appropriate insurance carrier within 24 hours of receipt of said information.
• Correspond with patients, policyholders, insurers, police, witnesses or other parties involved in the accident, and attorneys to obtain additional, relevant information to support the claim for monies owed.
• Review status of litigated claims (if applicable) and confer with attorneys and third party carriers regarding case disposition.
• Converse with the insurer(s) and appeal when appropriate to guarantee that all available benefits are recovered and that claims are reimbursed at the appropriate/maximum level(s).
• Use the operating systems (FACS, SSI etc.) to perform timely processing and follow up on every claim from initial placement thru resolution.
• Professionally respond to customer inquiries and requests that may require extracting, synthesizing, and analyzing system data.
• Prepare account summaries, offers of compromise, pro ration of funds, and compile other relevant data. Remain current with all local, state and federal statutes and act within the limits of the law.
• Understand all specific billing requirements for each applicable state and payer for which you are responsible.
• Establish and maintain constructive working relationships with insurance carriers, clients, external business contacts and staff.
• Demonstration of superior analytical skills.
• Possess above average communication and negotiation skills.
• Exceptional customer service skills and the ability to plan organize and exercise sound judgment.
• Excellent written and verbal communication skills.
• Outstanding time management skills.
• Ability to work effectively with insurers and attorneys in an effort to efficiently resolve claims, in a manner most advantageous to our clients.
• Ability to collect, synthesize and research complex and diverse information.
• Ability to sit at a computer station, using a keyboard, for a minimum of 7 hours per day.
• Ability to sit, bend, and reach.
• Ability to lift papers or boxes up to 5 lbs. occasionally.

About us:
Parallon is one of the healthcare industry's leading providers of business and operational services. We are uniquely equipped to provide a broad spectrum of customized services in the areas of revenue cycle, purchasing, supply chain, technology, workforce management, and consulting. Parallon is committed to supporting healthcare providers, improving the health and well-being of their communities.

We are an Equal Opportunity Employer.