overview

Required skills & experience (the “must haves” to be considered)

• Past work experience of at least one year within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing medical claims processing, financial counseling, financial clearance and/or customer service activities is required.

• Must have experience working with EOB's, COB's, ICD-10, CPT Codes. Know the difference between facility vs. professional claims (UB04 and CMS 1500)

• 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.

• Data entry skills (50-60 keystrokes per minutes).

• 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.

• Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-10, CPT, HCPCS), and basic computer skills are highly desirable. 

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.