Jumat, 09 September 2016

Insurance Follow Up Rep - Dupage Medical Group - Tinley Park, IL

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Insurance Follow Up Rep - Dupage Medical Group - Tinley Park, IL -
Excessive Faculty/GED

Midwest Doctor Administrative Providers (MPAS)


is an entirely owned subsidiary of DuPage Medical Group. MPAS was created in 2011 to offer an environment friendly approach of integrating and delivering administrative and medical providers to clients like Northwestern Drugs, College of Chicago Drugs and Edward-Elmhurst Well being.


We’ve got superb advantages and nice alternatives for progress!


SUMMARY:
Answerable for investigating and resolving precisely Insurance claims. Maximizes reimbursements via environment friendly, well timed and complete voucher, delinquent declare and denial management evaluation. Prepares appeals and tracks outcomes. Complies with all contractual, state and federal necessities. Troubleshoots case points and manages decision to completion. Acts as a affected person advocate by offering info and schooling on well being insurance advantages, billing, and the reimbursement course of to our clients.


ESSENTIAL DUTIES AND RESPONSIBILITIES:
Critiques and researches claims for denials purpose. Prepares and information appeals well timed. Completes Request for Reconsideration varieties following payor necessities and submits inside well timed submitting durations. Consists of all relevant medical documentation in accordance with HIPAA Privateness Requirements and to make sure most reimbursement. Follows established Affected person Accounts attraction tips. Processes insurance/affected person correspondence, VOC, and ticklers comply with-up based mostly on established Midwest Doctor Administrative Providers Insurance Follow Up unit insurance policies and procedures. Researches delinquent claims to determine payer and/or declare workplace tendencies, applies authorised payer rule changes, resubmits lacking claims, and reviews findings to supervisor. Identifies coding errors and prepares medical coding critiques. Maintains confidentiality of all info as stipulated within the HIPAA Privateness Guidelines and MPAS Confidentiality Coverage. Identifies coding errors and facilitates medical coding evaluation.


Deal immediately with clients both by phone. Solutions affected person questions, inquires and considerations relating to their accounts & reply promptly to their inquiries. Works with affected person to arrange bank card cost and applicable cost plans on their accounts the place relevant. Identifies any billing or insurance errors and is aware of the place to direct the difficulty for a decision. Follows-up on inquires despatched to see that a decision has been made. Deal with and resolve buyer complaints. Get hold of and consider all related info to deal with inquiries and complaints. Solutions affected person questions on basic info relating to physicians and our totally different places/websites.


Help with solutions telephones for customer support.


All different duties as assigned.


KNOWLEDGE SKILLS AND ABILITIES:
Evaluation Division and medical division coding coordinators on retro authorization requests and appeals. Includes Workforce Lead on complicated points or unanswered requests. Participates within the rotation of unit duties. Attends out there courses pertaining to place. Chargeable for sustaining correct and present useful resource materials. Makes use of materials appropriately when making determinations for declare appeals. Maintains division’s insurance policies and process timeliness and accuracy requirements. Performs different tasks and duties as associated to group’s aims.


Performs reconciliation of refund accounts; attaches documentation and forwards to supervisor to course of refund checks. Researches overpayments, identifies root causes or developments, processes refunds, takes corrective motion, and stories findings to supervisor. Answerable for engaged on credit score work queues and processing refunds for any transaction, unmatched in Epic, that leads to the quantity remaining undistributed.


EDUCATION and/or CERTIFICATION/LICENSURE:
Highschool diploma or GED.


EXPERIENCE:
Typing, pc information, proficiency in excel and phrase. Insurance information and background of CPT and ICD codes useful. Familiarity with 5010, claims funds and customer support background useful.


PHYSICAL AND MENTAL DEMANDS:
Entails extended durations of sitting, utilizing the phone and the pc. Requires good imaginative and prescient for engaged on a pc and listening to within the regular vary for phone calls. Work could also be irritating at occasions when having to cope with overseas service representatives.


WORK ENVIRONMENT:
Work is carried out in an workplace setting. Includes frequent contact with employees, sufferers and suppliers.


DISCLAIMER:
The above statements on this job description are meant to explain the character and degree of labor carried out by staff assigned to this job. They don’t seem to be meant to be an exhaustive listing of all duties, duties and expertise required


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