Claims Research Specialist ll

JOB SUMMARY 

Under the direction of the MedPro Claims Research Supervisor, the Claims Research Specialist II is responsible for performing the duties related to insurance follow up/collection and maintaining of accounts receivables. 

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Ability to work with major carriers (i.e. BCBS of FL, Medicare, Medicaid, etc.) accurately and efficiently.
• Familiarity with and ability to work all carriers with the exception of “Special Accounts” (i.e. WC, MVA, etc.).
• Work weekly claims worklist: Carrier specific worklist daily, No activity, Client Respond (Goal: 48 hours)
• Work insurance requests.
• Work correspondence.
• Work rebilled HCFA claim forms.
• Respond to questions from billing staff related to insurance or account A/R activity in a courteous and professional manner.
• Communicate with Claims Research Supervisor on carrier trends
• Perform error corrections.
• Ability to effectively communicate via claim notes per MedPro policy and procedure.
• Update patient accounts with the correct insurance information.
• Refile coding denials with appropriate material received from the Consultant Practice Manager (CPM) and/or coders.
• Complete assigned projects within deadlines, as directed by the Claims Research Supervisor.
• Perform daily functions with minimum guidance from Claims Research Supervisor.
• Other duties as assigned.

CORPORATE CULTURE RESPONSIBILITIES

• Follow established corporate and department-specific policies and procedures.
• Attend all corporate and department-specific required training.
• Uphold MCC’s Purpose, Values, and Vision.
• Abide by MCC’s Corporate Culture Responsibilities. 
• Perform other duties as may be assigned cheerfully and willingly. 

EDUCATION/EXPERIENCE REQUIREMENTS

• Minimum education requirement is high school diploma, or equivalent.
• Minimum 1-year insurance billing experience or equivalent, and minimum 1-year medical billing software or equivalent.

KNOWLEDGE, SKILLS AND ABILITIES

• Ability to prioritize and manage multiple tasks.
• Displays customer services skills, strong interpersonal skills, close attention to detail, excellent verbal and written communication skills, and basic math skills.  
• Be a person of integrity and character, willing to embrace change and make a positive impact in the lives of patients and co-workers.
• Ability to work with staff members at all levels of the organization in a cooperative, team-oriented manner.
• Displays computer proficiency (i.e. PC Windows, MS Office) and ability to quickly learn new applications. 
• Acceptable typing speed and accuracy with ten-key by touch skills.  
• Proficient in use of English language both in written and verbal communication. 
• Must be able to communicate with individuals of varying socio-economic backgrounds.
• Must be committed to the protection of confidential information, records and/or reports.
• Possess strong critical thinking and analytical skills. 

PHYSICAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally)
• Standing/Walking: Occasionally; activity exists up to 1/3 of the time
• Keyboarding/Dexterity: Frequently; activity exists from ¾ of the time
• Ability to look at a computer screen for extended periods.
• Ability to perform constant repetitive hands and finger motions.
• Ability to maintain focus while working in close proximity to others.
• Talking (Must be able to effectively communicate verbally): Yes
• Seeing: Yes
• Hearing: Yes 

EMOTIONAL REQUIREMENTS OF THE ESSENTIAL JOB FUNCTIONS

• Must exhibit stable work behaviors daily.
• Must possess adequate individual coping skills.
• Ability to remain calm and professional regardless of workload or time constraints. 
• Must be able to work under stress and remain calm and professional. 

WORK ENVIRONMENT

• Office environment.
• Exposed to frequent and constant interruptions in daily functions/schedule. 
• May be required to work extended hours to meet department needs.