Position Summary:
The position performs all functions needed to review and evaluate insurance claims related to toxicology testing and laboratory services.
You will assess claims for accuracy, compliance with policy terms, and adherence to regulatory guidelines.
Your attention to detail and knowledge of laboratory practices will be essential in making informed decisions that ensure fair and timely claim resolutions.
This role will need to use innovative approaches to collect updated information and balances while still providing a high level of customer service and time management.
Salary: $38-$46K
Non-exempt/ Hourly postion
Essential Functions:
• Consistently meets performance standards set by manager.
• Performs various billing and collections actions including contacting payors by phone, email, fax, and direct mail.
• Contributes to a positive work environment by demonstrating accountability, flexibility and continuous improvement.
• Review and assess insurance claims related to laboratory services to determine their accuracy and compliance with insurance policies and industry regulations.
• Analyze medical records, test results, and other relevant documents to make informed decisions on the validity of claims.
• Communicate with laboratory staff, healthcare providers, and policyholders as necessary to gather information and clarify claim details.
• Ensure that claims are processed in accordance with insurance policy terms, while staying updated on relevant regulations and guidelines.
• Maintains strictest confidentiality; adheres to HIPAA guidelines/regulations.
• Work within defined timeframes to process claims efficiently and meet established service level agreements.
• Participate in continuous quality improvement efforts to maintain high standards of adjudication services.
Additional Duties:
• Provides support for the department and assists with special projects, as assigned
• All other duties as assigned
Education and Experience:
• Associate degree or higher but may substitute for years of experience
• Medical Billing Certification or Degree with an accredited school, a plus
• 3+ years of Billing experience
• Customer Service experience is preferred
Knowledge, Skills, and Abilities:
• Self-motivated and organized professional
• Attention to detail and adherence to departmental protocols
• Maintains acceptable standards of attendance, punctuality and dependability
• Ability to adapt and retain training provided
• Ability to thrive in a fast-paced environment
• Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar.
• Strong oral, written and interpersonal skills
• Ability to maintain a high level of confidentiality, integrity, and professionalism.
• A working knowledge of Microsoft Word, Excel and Outlook
• Comfort working with personal computers and learning new computer systems/software
• Personal confidence in abilities
• Able to pass background check and drug screen including but not limited to OIG exclusion
Physical Requirements:
• Light to moderate physical effort (lift/carry up to 25 lbs.
) -Heavier weights with assistance
• Sitting & standing for long periods of time
• Repetitive motions and/or prolonged computer use
• Working at a fast pace, subject to many interruptions and both physical and mental stress
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