This position requires a basic working knowledge of health insurance claims processing. The individual must be able to apply Coordination Of Benefits / Medicare rules and order of benefit determination.
Responsibilities include researching claims to validate overpayments – this research is done by accessing claims processing system so the candidate must have the ability to be able to negotiate through multiple databases and operating systems. This individual will be working on behalf of our clients, it is important to possess a confident yet polite telephone manner and the ability to clearly indicate why a claim is overpaid.
Responsibilities and job functions
- Using information provided by our client, the candidate must be able to validate that a claims is overpaid. Candidates will have remote access to client’s payment system for research
- Once the overpayment is validated, the candidate will contact the provider of service or billing agency. At times, internet searches are needed for this task
- After research is complete, candidate must contact the provider and justify the overpayment, and ask necessary questions to uncover any type of information that could assist DHP in recovering overpayments for our clients
- Initiate recovery of overpayment in writing, clearly stating the reason our client is entitled to a refund
- Pursue the overpayment with continued follow-up with providers/billing services to ensure that the refund is being processed
- Handling provider disputes on overpayments
- Negotiate payment plans with providers
- Tracking recovery and/or processing time on overpaid claims
- Clearly update and maintain information in DHP’s application
- Intermediate Word and Excel skills, typing skills of 45 wpm minimum, and knowledge of scanning, faxing and email
- Confident telephone manner
- Basic knowledge of health claims processing and ability to read explanation of benefit statements from insurance companies
- Must be comfortable using various databases and computer systems to research and investigate payment of claims
To apply for this position, please send your resume to email@example.com.