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MANAGED CARE REPRESENTATIVE
From:
Company: Hammond Clinic Specialty Center (see all of this employer's jobs)
Phone: 2198365800
Fax: 1234567890
 Apply by eMail:do_not_reply@invalidemail.com
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Job Reference ID:
5006019
Category:
Administrative/Clerical
Duration:
Fulltime, Permanent
City, ST:
Munster, Indiana
Country:
United States |
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Description:
SUMMARY OF DUTIES:
Responsible for quality customer service. Focus is to answer questions and assist in resolving problems for patients, co-workers, outside employer groups, physicians; hospital staff and insurance companies regarding manage care problems, referral issues, outside claims and benefit coverage. Perform routine office duties to ensure efficiency of department.
ESSENTIAL JOB FUNCTIONS: (This list does not include all responsibilities but “essential”.) 1. Receives inquiries in-person, by phone, fax, and in-writing and then assists patient, agency, coworker, physician, hospital, and all others by investigating and resolving problems timely and accurately. 2. Retrieves from fax machine, throughout the day general correspondence and claims. If needed, investigates completes fax requests the same day or as appropriate. 3. Reviews and analyzes daily external-insurance company claim reports to determine responsible party and to ensure timely and accurate reimbursement payments by either the Hammond Clinic or the insurance company on each claim. Immediately report errors to appropriate person for further review and follow-up. 4. Receives and reviews various reports regarding Diagnostic Testing and Outside Services, verifies accuracy of responsible party, accurately enters appropriate charges into the MC software, and forwards to next party for processing. Also, respond to referral inquires regarding these services/test. 5. Open, date stamp, sort and distribute interoffice and U.S. mail received daily. 6. Conducts the preliminary external-claim review for newly received claims. Enters corresponding information into MC computer system. Claims are then redirected to the appropriate claims staff, insurance company or the billing vendor in a timely manner. 7. Assists in the review of designated internal managed care patient accounts to ensure timely and accurate billing and payment and maximum clinic reimbursement. Review reports and determine if accounts have been properly credited in accordance with individual contracts. Ensure account transfer requests are redirected to the appropriate staff. 8. Alphabetizes and files all paid claims and miscellaneous correspondence. 9. Other duties as assigned by the Director or Supervisor.
EDUCATION
High School diploma or equivalent.
EXPERIENCE/KNOWLEDGE/ABILITIES/LICENSE/CERTIFICATION
¨ Medical terminology knowledge preferred.
¨ 1 year demonstrated customer service experience
¨ 1-3 experience medical or insurance experience
¨ 1-year experience entering and accessing data in various software programs.
Apply by eMail:do_not_reply@invalidemail.com
Job Created:
Tue Sep 29 2009 06:09:38 AM
Last Modified: Fri Nov 20 2009 05:52:13 AM
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