|Job Title||Insurance / Private Pay Representative|
|Department||Patient Financial Services|
Purpose of Your Job Position
The Insurance Representative is responsible for accurate coding and follow-up on insurance claims and resolve unpaid claims in a timely and efficient manner while maintaining the minimum production standards set by the Director of Patient Financial Services.
Patient Financial ServicesClerical Job Duties:
- Manage own time and work assignments effectively.
- Seek advice/feedback in terms of priorities or issues when necessary.
- Process claims within an appropriate timeframe (e.g. claim status check, appeals of denied claims).
- Recode claims into the Accounts Receivable billing System as necessary.
- Update appropriate modifiers based on origin and destination of the trip and change insurance claims as necessary.
- Ensure charges are billable to a particular insurance based on the payer’s criteria (e.g. prior authorization) as needed.
- Resolve payment issues with payer (e.g. denials, partial payments, etc.).
- Refile and appeal claims as necessary.
- Process incoming correspondence, including signature letters, denials, and additional information necessary to release the claim.
- Forward all credit card payments to the Accounts Receivable Representative when identified in the Patient Care Report (PCR), correspondence, and or Computer Aided Dispatch (CAD) notes.
- Review clearinghouse transmission listings and carrier acknowledgment reports to make appropriate corrections as required.
- Determine the appropriate level of service to be billed based on supporting documentation on the PCR and or in the CAD notes, including but not limited to, designating Advanced Life Support (ALS), Basic Life Support (BLS), Wheelchair, Specialty Care Transport (SCT), or Critical Care Transport (CCT).
- Assign appropriate condition code/ICD-9 codes into the Accounts Receivable Billing System.
- Accept incoming calls from payers, providers, and patients.
- Process “Very Important Person” (VIP) transports by verifying information with Director of Patient Financial Services.
- Verify eligibility of benefits via internet and or telephone.
- Escalate the appeal process as needed.
- Perform other duties as assigned and required.
- Work in a spirit of teamwork and cooperation.
- Convey a sense of competence and commitment.
- Use initiative to learn new skills, enhance personal knowledge and improve communications.
- Demonstrate the ability to work well with team members.
- Communicate a willingness to help others succeed.
- Share workspace and resources as necessary.
- Medical transportation processes.
- Understanding of the terminology of a PCR, Hospital Face Sheet, and or a CAD sheet.
- Understanding of the distinctions between the different level of service (e.g. ALS, BLS, Wheelchair, SCT, and CCT).
- Understanding of insurance carrier coverage guidelines, filing limits, and necessary prior authorizations.
- Understanding of insurance contracts.
- HIPAA requirements.
- Flexible with shifting daily priorities.
- Meet deadlines working within tight time constraints.
- Handle large volume of work and or telephone calls.
- Recognize improper fee schedules.
- Recognize overpayments and request refunds as necessary.
- Prioritize workflow.
- Process clean claims.
- Exceed minimum quality performance standards consecutively for a minimum of six months, and maintain those standards for a minimum of four out of every six-month rolling time-period.
- Ability to meet, exceeds, or sustains established standards for productivity.
- Ability to communicate effectively, both orally and in writing, in English.
- High School Diploma or GED required; Associates Degree or Technical Certification in Coding and Billing preferred.
- Occasional light lifting of paper files and office equipment.
- Mandatory and or voluntary overtime.
- Office environment (cubicles).
- General collating equipment.
- Copy machine, scanners, fax machine.
- Personal computer, telephone.
This document in no way constitutes a contract of employment. This description is not intended to be an exhaustive listing of all skills, duties, or responsibilities associated with the job. Management reserves the right to revise the job, or to require that other or different tasks be performed, should circumstances change (e.g. changes in personnel, workload, or technological developments).