MedData has an excellent career opportunity available as a Claims Rep - Appeals & Denials to work in a Regional office located in Draper, UT. The schedule for this Temporary full time role is Monday- Friday 8am- 5pm.
The purpose of this position is to investigate, facilitate, and escalate denied insurance claims due to an unresponsive patient denial to ensure timely reprocessing and resolution. This position will follow a claim with the insurances thru to payment in full with the facility. This position is responsible for providing a delightful experience for our patients, insurances, and our hospitals.
ESSENTIAL JOB FUNCTIONS:
- Review and research insurance carriers to determine accurate payer order
- Contact various sources including insurance professionals, employers, patients, and other parties to verify relevant data
- Coordinates with appropriate payers to ensure correct processing guidelines are met for reimbursement
- Request information, both verbally and written, from appropriate parties to ensure proper claim disposition
- Maintains and updates proper account documents and information in multiple systems
- Ensure that appropriate billing guidelines and standards are met based on payer and/or project specific processes
- Investigate and understand various denial types, explanation of reviews, and steps for reprocessing
- Performs aggressive follow upon unresolved claims and facilitates payment from appropriate payers, including escalating claim processing
- Make written or verbal appeals to payers on denied claims
- Ability to meet account and productivity expectations within allotted timeframe
- Responsible for obtaining claim status and gathering supporting documentation to submit for appeals
- High School Diploma or GED
- Some college coursework preferred
- Ability to communicate effectively verbally and in writing and be able to speak professionally with patients and insurance companies
- Proven ability to be assertive in order to critical think and proactively resolve issues
- Demonstrate ability to organize and set priorities accordingly to meet all demands
- Excellent customer service skills
- Must have experience with data entry and word processing, be capable of operating routine office equipment, possess a working knowledge of MS Office applications, understand how to navigate through web-based applications, and the ability to learn in-house computer applications
- Positive team player attitude and mindset
- 0-3 years of related experience in the field or in a related area
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 25 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,000 employees and growing, please apply directly to this posting.
MedData is an Equal Opportunity Employer