Company: Claimpay Inc
Posted on: February 9, 2024
Description: Claims Account Services Representative Job
DescriptionThe Claims Account Services Representative is
responsible for conducting follow-up on outstanding claims,
gathering additional information requested, and basic billing
functions, including claim corrections, resubmissions, and appeals.
Meets department targets regarding productivity and claim
resolution and re-submits claims as needed. Assisting with
follow-up requests from payors and evaluating unresolved workers
comp claims to facilitate resolution. CAS Representatives at
Claimpay, Inc. are a specific subset of collectors and specialize
in all debts relating to Workman's Compensations patients who
receive in office dispensed medication.The first step of a CAS
Representative is to contact insurance companies and claim
adjusters to verify the status of reimbursement on unpaid claims
that are aged over 45 days. This is accomplished mainly via
telephone contact and/or verification from Insurance Company
Provider Portals. If a claim is denied, the CAS Representative will
obtain the Explanation of Benefits from the Claims Adjuster, as
well as prepare and submit the necessary appeal to obtain
reimbursement. The CAS will assign a ----- Claim Status' and
provide ----- Notes' in the billing software for all actions taken
on a patients claim. The CAS will continue to monitor the claim
until reimbursement is obtained, or determination of the claim is
rendered non-compensable.CAS Representatives are responsible for
all functions related to the collection on patient claims. Duties
are generally assigned on a primary basis, but all personnel are
cross-trained and may perform functions in the various business
- Communicate directly with insurance companies regarding their
financial responsibility from services with our clients.
- Document all calls timely and accurately in the patients'
account in the billing system to achieve timely reimbursement.
- Perform insurance claim follow-ups for insurance denials and
- Contact insurance companies to check eligibility and benefits
via phone or online portals.
- Assist with other billing/collection duties, as needed.
- Performs claim follow-up with insurance carriers and claims
adjusters on billed claims with no response (no payment or denial
received) to obtain claim status and Explanation of Benefits.
- Utilize carrier portals to obtain missing Explanation of Review
(EOR) to assist management in the appeals process.
- Review incoming correspondence from payors.
- Reports to management any consistent errors or trends
identified with billing or payors that affect timely and accurate
- Assist in gathering missing or additional supporting
documentation necessary to resubmit claims.
- Participates in continuous quality improvement efforts,
regularly establishes goals with supervisors, and tracks
- Maintain confidentiality of PHI.Requirements: Qualifications
- High School Diploma or equivalent; Associates Degree
- 2 years of office experience in medical billing / collections
- Must possess knowledge of Explanation of Benefits (EOB's) and
understanding of copays, coinsurance, deductibles, and denial
- Attention to detail and have the ability to prioritize
- The ability to multi-task and in a busy office
- Proficient customer service skills.
- Intermediate knowledge of MS Office.
- Knowledge of medical billing/collection practices.
- Ability to read and interpret documents such as safety rules,
operating and maintenance instructions, and procedure manuals.
- Ability to write routine reports and correspondence. Ability to
speak effectively before groups of customers or employees of an
- Ability to add, subtract, multiply, and divide in all units of
measure, using whole numbers, common fractions, and decimals.
- Ability to apply common sense understanding to carry out
instructions furnished in written, oral, or diagram form.
- Ability to deal with problems involving several concrete
- Interpersonal skills
- Communication skills -verbal and written
- Listening skills
- Problem analysis and problem-solving
- Stress toleranceCompensation details: 15-16 Hourly Wage
Keywords: Claimpay Inc, Mobile , CAS Representative, Other , Mobile, Alabama
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