MedData has an excellent career opportunity available as a Claims Representative - Workers Comp based in our beautiful new office located in Draper, Utah. This is a full time position Monday - Friday 6:00 am - 2:30 pm.
The purpose of this position is assist hospitals and providers in resolving accounts that are a result of work related injuries. Specifically, this position is focused on the effort to obtain Workers’ Compensation injury details and insurance information from hospital, employers, patients and from other sources (including telephone, mail, email and fax), submission of insurance bills and documentation to Workers’ Compensation insurance carriers, and to communicate with both insurance carries, employers, attorneys and patients during the claims adjudication process to ensure that the hospital and/or providers receive payment on submitted bills and denied claims.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Maintain a queue of Workers’ Compensation accounts as assigned by management.
- Maintain quality and productivity levels set by management, once full job proficiency has been achieved.
- Contact patient’s employer, Workers’ Compensation carrier, and injured worker via telephone and mail to obtain injury information and insurance information.
- Support patients by answering any questions about the Workers’ Compensation process.
- Coordinates with appropriate client personnel to ensure appropriate filing guidelines are met for reimbursement.
- Requests appropriate information, both verbally and written, from appropriate parties to ensure proper claim disposition. Perform manual data entry of patient accounts and or claim forms.
- Perform manual data entry of patient accounts and/or claim forms
- Submit hospital and physician bills to insurance companies for payment.
- Maintain contact with insurance adjusters/carriers, employers and patients during the claim adjudication process to ensure that the hospital and physician bills are paid timely and in full.
- Responsible for obtaining claim status and gathering supporting documentation to submit appeals.
- Provide strong customer service to clients and provide responses to client inquiries within 24 hours.
- Provide detailed updates to MedData’s account management system and hospital/provider practice management system as account work is completed.
- Assist in training both new and existing employees, which may include contributing specific training material.
- Escalate complex, complicated or challenging accounts to management to ensure accounts are progressing effectively.
- Identify and discuss root cause issues with management.
- Maintains and updates proper account documents in multiple systems.
- Assist management with ad hoc inventory initiatives and other projects, as needed.
- Makes written or verbal appeals to payers on denied claims.
- Other duties as assigned.
QUALIFICATIONS AND REQUIREMENTS
- 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 insurances
- Proven ability to be assertive in order to proactively resolve issues.
- Demonstrate ability to organize and set priorities according to situation all demands
- Working knowledge of computer functions including the internet and computer software such as Microsoft Office Suite and the ability to learn in-house computer applications.
- 0-1 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