Medical Claims Creation Representative

JOB TITTLE: Claims Creation Representative

DEPARTMENT: Claims

REPORTS TO: Supervisor

JOB SUMMARY: Ensures our providers are reimbursed accurately by translating medical services into insurance claims: auditing patient data, coding procedures (CPT and ICD-10), submitting claims to payers, managing clearinghouse and insurance rejections, and deliver a 99% first pass rate.

JOB DUTIES/RESPONSIBILITIES – The main goal is to submit claims daily with a 99% average first pass rate. Some of their primary day-to-day responsibilities include:

• Accurately prepare and submit claims to primary, secondary, and tertiary insurance payers
• Review medical records for accurate CPT, ICD-10, and HCPCS codes to minimize rejections
• Verify patient eligibility and insurance coverage prior to billing
• Follow up on rejected claims and investigate issues prior to resubmission
• Posting electronic or paper EOBs, and working account aging, if necessary
• Maintain strict confidentiality in accordance with HIPAA regulations
• Handle patient billing inquiries, explain EOBs, and set up payment plans if necessary
• Communicate with insurance representatives, other departments within the billing office, and management team
• Maintain knowledge of payer requirements and coding standards (ICD-10, CPT)
• Achieve team productivity and performance benchmarks consistently
• Performs other related duties as assigned by management

SUPERVISORY RESPONSIBILITIES: This job position has no supervisory responsibilities.

QUALIFICATIONS/KNOWLEDGE/SKILLS:

• High school Diploma or equivalent
• Some college courses - Preferred but not required
• Strong written and interpersonal communication skills
• High level of accuracy and problem-solving ability
• Systems and software proficiency, including Microsoft Office
• Ability to maintain confidentiality and exercise extreme discretion
• Coding classes/certification - Preferred
• Medical billing or coding experience required

Success Criteria

• Achieve team productivity and performance benchmarks consistently
• Maintain a 99% or higher first pass rate
• Ensure all tasks and projects are completed within the established deadlines
• Maintain a culture of trust and accountability within their team

STANDARD PHYSICAL DEMANDS AND WORKING CONDITIONS: The work is performed in a conventional medical office setting. It requires manual dexterity to operate keyboard and other office equipment; sitting at computer terminal for long periods of time; corrected vision and hearing to normal range; and the occasional overtime to complete tasks for accurate Month End Reports.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be taken as a complete description of all duties, responsibilities, or physical requirements. Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Job Type: Full-time

Pay: $14.00 - $20.00 per hour

Benefits:

• Paid time off

People with a criminal record are encouraged to apply

Work Location: In person