HCA, Hospital Corporation of America Claims Representative in Wakefield, Massachusetts
Process claim files for payment from Workmen’s Compensation, Automobile, Property and Casualty, and Health Insurers. Contact Attorneys to maximize client reimbursements for services and recover all monies properly owed to our clients. Identify viable payer(s) and obtain all necessary documentation to properly process the claim for payment including, when applicable, IBs, UBs, Medical Records, POs, EOBs when necessary. Coordinate benefits with all available payers to appropriately maximize the client’s recovery while minimizing the patient’s personal responsibility. Review and process for payment all claims, in which adequate billing information has been obtained, to the appropriate insurance carrier within 24 hours of receipt of said information. Correspond with patients, policyholders, insurers, police, witnesses or other parties involved in the accident, and attorneys to obtain additional, relevant information to support the claim for monies owed. Review status of litigated claims (if applicable) and confer with attorneys and third party carriers regarding case disposition. Converse with the insurer(s) and appeal when appropriate to guarantee that all available benefits are recovered and that claims are reimbursed at the appropriate/maximum level(s). Use the operating systems (FACS, SSI etc.) to perform timely processing and follow up on every claim from initial placement thru resolution. Professionally respond to customer inquiries and requests that may require extracting, synthesizing, and analyzing system data. Prepare account summaries, offers of compromise, pro ration of funds, and compile other relevant data. Remain current with all local, state and federal statutes and act within the limits of the law. Understand all specific billing requirements for each applicable state and payer for which you are responsible. Establish and maintain constructive working relationships with insurance carriers, clients, external business contacts and staff. All Claims Representatives must maintain the highest level of confidentiality and comply with all HIPAA regulations and Business Associate Agreements with its clients.
Must have experience in reading and understanding UB04 and HCFA forms. Along with experience in Workman’s Compensation and Motor Vehicle Claims processing Demonstration of superior analytical skills (ex. possesses the capacity to quickly and accurately review a claim making sound "next step" decisions designed to most effectively bring the account to a successful conclusion). Possesses above average communication and negotiation skills. The ability to work effectively with insurers and attorneys in ones effort, to efficiently resolve claims in a manner most advantageous to our clients. Maintains the ability to collect, synthesize and research complex and diverse information. Exceptional customer service skills and the ability to plan organize and exercise sound judgment. "Team Player" willing to help whenever needed to maintain client satisfaction and achieve company goals. Displays good decision making skills and makes few errors. Minimum of Associates Degree with related experience and/or 3 years of directly related industry experience in lieu of degree Excellent written and verbal communication skills Outstanding time management skills. High energy, self-motivated and achievement oriented. Demonstrated professionalism at all times. MS Office Professional (Word, Excel, and Outlook) proficiency required Ability to sit at a computer station, using a keyboard for a minimum of 7 hours per day. PHYSICAL DEMANDS/WORKING CONDITIONS – Requires sitting, some bending and reaching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Requires normal range of hearing and eyesight to record,
Title: Claims Representative
Location: Massachusetts-Wakefield-Wakefield (WAK) - RCPS
Requisition ID: 26579-124439