Healthcare CSR (Billing) - Remote - Up to 35K

We are looking for CSRs for a client in the Healthcare Industry.

This role is on a REMOTE setup and follows a Night Shift Schedule.

Salary pays up to 35K Package

Minimum requirement of at least 3 years of Healthcare experience in a BPO setup

Essential Duties and Responsibilities:

• Processes opportunities, such as verifying benefits, requesting authorization, & following up on auth-requests.
• Completes data fields within the system with insurance information needed for claim submission, start & end dates of authorization, and others
• Prepares correspondence to insurance companies, Health Care Professionals (HCPs) & other affiliates on behalf of patients, such as authorization requests, appeals & letters of agreement
• Clearly documents all correspondence in the company databases.
• Troubleshoots and seeks solutions to problems related to questions and concerns over authorization and claims.
• When other team members are absent or not available, provides backup coverage for their territories/insurance/state.
• Support education of team members on insurance verification, authorization, and claims
• Analyze and investigate denied claims and find ways/resolution for payment.
• Do outbound calls to different insurance companies to confirm information, submit/validate an authorization or claim submission/denials.
• Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up and/or root cause resolution.
• Assumes and performs other duties as assigned.

Required Qualifications:

STRONG US HEALTHCARE COMPREHENSION

• Must understand the intricacies of medical and pharmacy insurance coverage.
• Must know and understand the difference between HMO, PPO, EPO, Indemnity, POS, Home Plans and Host Plans and be able to clearly communicate that to a patient and or another caregiver or medical professional.
• Must understand different denial reasons and claim status.
• Must understand CPT/HCPC codes, ICD 10, claim forms.
• Ability to learn and retain the specific criteria and requirements for different insurance plan

STRONG COMPUTER AND PHONE SKILLS

• Must be able to create Word documents, work in Excel, use templates, use the internet, Outlook and work in a company created database
• Must be pleasant and knowledgeable when speaking with insurance company representatives

Preferred Qualifications:

• 3 years of US HEALTHCARE experience Authorization and billing experience or insurance collections preferred.
• Proven knowledge of and experience with ICD-9/10, HCPCS, and modifier coding.
• Outstanding interpersonal, verbal, and written communications skills required.
• Must be flexible and able to work in a fast-paced, heavy volume work environment.
• Demonstrated computer, prioritization, and time management skills.
• Experience working at insurance companies/payors or with medical device reimbursement for a start-up or new technology company or durable medical equipment setting is high desirable.

Education and Experience Requirements:

• Bachelors degree preferred.

Language Skills:

• Must be able to communicate effectively in English.
• Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
• Ability to write routine reports and correspondence.
• Ability to speak effectively before groups of customers or employees of organization.

Originally posted on Himalayas