CLAIM SUBMISSION REPRESENTATIVE-HYBRID - Growth-Minded Organization

Perform electronic claim submission for all payers. Correct first pass claim edit errors from Practice Management System. Correct clearinghouse errors. Submit paper claims with appropriate documentation as needed.

• Attend department, clinic or company meetings as required
• Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns
• Consistently work in a positive and cooperative manner with fellow staff members.
• Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Attend required annual in-service programs.
• Demonstrate knowledge and understanding of all company policies and procedures. Adheres to established facility safety requirements and procedures to ensure a safe working environment. Identifies potentially unsafe situations and notifies supervisor.
• Adaptability to changing procedures and growing environment.

• Assure timely and accurate submission of claims to maintain the highest quality of service and timely payment.
• Submits all paper claims and supporting documentation as required by payers.
• Reports any errors trends/delays to supervisor.
• Researches and resolves any electronic claim delays within 24 hours.
• Correction of clearinghouse errors.
• Participates in continuing educational activities relative to assigned duties and responsibilities.

• Perform other duties as assigned by management.

• High school graduate or equivalent.
• Medical Billing Experience including CPT and ICD10
• Medical Accounts Receivable, Denial Management, or Clearinghouse Rejection Experience

• Experience with electronic health records/practice management system.
• NextGen PM and NextGen EHR
• Waystar experience preferred
• Understanding of major insurance carriers including, HMOs, PPOs and governmental payers.
• Proficiency in Explanation of Benefits (EOB) methodologies and principles.
• Sound judgment, maturity, and an ability to establish good rapport with patients, public, and staff.
• Proficiency with Microsoft Teams, Outlook, and Excel
• Ability to calmly handle multiple tasks at once, and deal with patients and staff with tact and diplomacy.