CLAIM SUBMISSION REPRESENTATIVE-HYBRID

Job Description

Job Description

Full-Time: Monday through Friday

Training to be completed onsite at Summit

Hybrid with 1 Day in Office

Position Summary:

Perform electronic claim submission for all payers. Correct first pass claim edit errors from Practice Management System. Correct clearinghouse errors. Submit paper claims with appropriate documentation as needed.

Position Responsibilities/Standards:

General

• Attend department, clinic or company meetings as required
• Demonstrate sound judgment by taking appropriate actions regarding questionable findings or concerns
• Consistently work in a positive and cooperative manner with fellow staff members.
• Consistently demonstrate ability to respond to changing situations in a flexible manner in order to meet current needs, such as reprioritizing work as necessary.
• Attend required annual in-service programs.
• Demonstrate knowledge and understanding of all company policies and procedures. Adheres to established facility safety requirements and procedures to ensure a safe working environment. Identifies potentially unsafe situations and notifies supervisor.
• Adaptability to changing procedures and growing environment.

Specific Duties

• Assure timely and accurate submission of claims to maintain the highest quality of service and timely payment.
• Submits all paper claims and supporting documentation as required by payers.
• Reports any errors trends/delays to supervisor.
• Researches and resolves any electronic claim delays within 24 hours.
• Correction of clearinghouse errors.
• Participates in continuing educational activities relative to assigned duties and responsibilities.

• Perform other duties as assigned by management.

Education/Experience Required:

• High school graduate or equivalent.
• Medical Billing Experience including CPT and ICD10
• Medical Accounts Receivable, Denial Management, or Clearinghouse Rejection Experience

Experience Preferred:

• Experience with electronic health records/practice management system.
• NextGen PM and NextGen EHR
• Waystar experience preferred
• Understanding of major insurance carriers including, HMOs, PPOs and governmental payers.
• Proficiency in Explanation of Benefits (EOB) methodologies and principles.
• Sound judgment, maturity, and an ability to establish good rapport with patients, public, and staff.
• Proficiency with Microsoft Teams, Outlook, and Excel
• Ability to calmly handle multiple tasks at once, and deal with patients and staff with tact and diplomacy.

Work Environment/Physical Requirements:

Position is located inside with moderate noise level, good lighting and even temperatures. Physical requirements for the position include the ability to frequently hear and communicate orally, see up close and at a distance, read and comprehend, stand, sit, walk, reach, handle, and/or feel objects. Maximum unassisted lift = 25 lbs. Average lift less than 10 lbs.