Claims Service Rep | Hospice Administration | FT Day

If you are looking to make an impact on a meaningful scale, come join us as we embrace the Power of One!

We strive to be an employer of choice and establish a reputation for being a talent rich organization where Associates can grow their career caring for others. For over a century, we’ve served the health care needs of the people of Memphis and the Mid-South.

Responsible for resolving more complex outstanding unpaid and/or unprocessed medical claims and denied claims submitted to third party payers on behalf of SPG providers. Works closely with CBO staff to capture denial data in the interest of denial prevention and provider education. Resolves outstanding claims by accessing third party payer web sites, making and accepting phone calls, and sending and receiving correspondence to and from third party payers and various government agencies. Works under minimal supervision and may adapt procedures, processes, and techniques to meet the more complex requirements of the job. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

Working at MLH means carrying the mission forward of caring for our community and impacting the lives of patients in every way through compassion, a deliberate focus on service expectations and a consistent thriving for excellence.

A Brief Overview
Responsible for resolving more complex outstanding unpaid and/or unprocessed medical claims and denied claims submitted to third party payers on behalf of SPG providers. Works closely with CBO staff to capture denial data in the interest of denial prevention and provider education. Resolves outstanding claims by accessing third party payer web sites, making and accepting phone calls, and sending and receiving correspondence to and from third party payers and various government agencies. Works under minimal supervision and may adapt procedures, processes, and techniques to meet the more complex requirements of the job. Models appropriate behavior as exemplified in MLH Mission, Vision and Values.

What you will do

• Reviews more complex accounts, files appropriate claims, and provides follow-up on claims. Evaluates account status and performs follow-up to insure account resolution. Ensures follow-up on adequate number of accounts according to department policy
• Contacts insurance company to check verification and eligibility.
• Makes notations on accounts worked to indicate status of account, ties and unties accounts, and uses wait dates and dispositions to ensure maximum productivity.
• Contacts patients and insurance companies to identify barriers in getting more complex claims paid. Contacts patients to obtain information or request their involvement in claim resolution, insurance problems, or non-payment.
• Routes more complex accounts back to appropriate parties after self-pay balances are determined.
• Provides research on more complex bill disputes, handles adjustments and follows up on outstanding claims. Determines when adjustments are required and prepares accounts for write-off.
• Performs other job functions as assigned or requested.

Education/Formal Training Requirements

• High School Diploma or Equivalent

Work Experience Requirements

• 1-3 years Billing
• 1-3 years Customer service

Knowledge, Skills and Abilities

• Strong organizational and time management skills.
• Strong telephone, communication and diplomacy skills.
• Personal computer skills for the purpose of accessing information on the internet and other applications to obtain information.

Supervision Provided by this Position

• There are no supervisory or lead responsibilities assigned to this position. Assists the Lead and Supervisor with training/orienting and providing guidance to lower level staff members.

Physical Demands

• The physical activities of this position may include climbing, pushing, standing, hearing, walking, reaching, grasping, kneeling, stooping, and repetitive motion.
• Must have good balance and coordination.
• The physical requirements of this position are: light work - exerting up to 25 lbs. of force occasionally and/or up to 10 lbs. of force frequently.
• The Associate is required to have close visual acuity to perform an activity, such as preparing and analyzing data and figures; transcribing; viewing a computer terminal; or extensive reading.
• The conditions to which the Associate will be subject in this position: The Associate is not substantially exposed to adverse environmental conditions; job functions are typically performed under conditions such as those found in general office or administrative work

Our Associates are passionate about what they do, the service they provide and the patients they serve. We value family, team and a Power of One culture that requires commitment to the highest standards of care and unity.

Education:

High School Diploma or Equivalent (Required)

Work Experience:

Billing, Customer service

Certifications:

Boasting one of the South's largest medical centers, Memphis blends a friendly community, a thriving and growing downtown, and a low cost of living. We see each day as a new opportunity to make a difference in the lives of the people in our community.