Medical Claims Follow-Up Specialist Job Vacancy in J&k Pms Inc. Fort Worth, TX 76112 – Latest Jobs in Fort Worth, TX 76112 – updated today

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Company Name : J&k Pms Inc.
Location : Fort Worth, TX 76112
Position : Medical Claims Follow-Up Specialist

Job Description : FUNCTION OVERVIEW:
As a Claim Representative this position will be instrumental in analyzing and following up on billed medical claims to determine the appropriate course of action to resolve the claims.
REPORTS TO: Project Manager or Facility Manager
FINANCIAL RESPONSIBILITIES:
Direct Accountability
h Resolve cash generating accounts expeditiously to bring in revenue for the client and the company.
Deliverables:
h Able to work an average of 60 accounts per day 100% of time
h Able to work accounts with 5% or less error ratio
DUTIES:
Work an average of 60 Accounts per Day:
h Follow up on Commercial, Worker’s Comp and VA medical claims by phone calls to the insurance companies, websites, if available, or any online resources. Phone calls to the patient may be necessary as well.
h Understanding of medical terminology, diagnosis codes, denial codes, ICD 9-10 Codes, and calculating fee schedules.
h Experience in filing appeals on denied claims when appropriate while working each account/claim.
h Strong understanding of UB’s, 1500’s, Remittance Advice (RA’s).
h Ability to read and understand EOB’s (Explanation of Benefits).
h Able to read and understand the Worker’s Compensation Labor Codes and applying them when following up on Work Comp. Claims
h Has the experience to know the appropriate questions to ask when calling Medical Insurance companies, Worker’s Compensation, or Veterans Administration to get the necessary information to move forward in resolving the claim.
Job Description
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h Understands hospital revenue cycle process and is able to apply when working account.
h Develops a solid understanding of assigned client processes in order to review and analyze claims and account receivable functions.
h Identifies client issues consistently and communicate this to their Manager timely for quick resolution.
Works accounts with a 5% or less error ratio:
h Include key information in account notes consistently
h Able to ask questions, if unclear, on facility specifics or PMS processes.
h Able to use the appropriate reason and status codes in the PMS system for each account
h Able to request the correct information from the appropriate entity when attempting to resolve the account.
h Able to ask the appropriate questions when calling insurance companies, doctors’ offices, or the patient.
REQUIREMENTS:

Personality Traits Sense of urgency
Detail Oriented

Analytical
Stable

Organized
Adaptable

Likes to follow rules
Flexible

Positive
Thorough

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