Remote Insurance Utilization Review Jobs in Virginia

Description

Summary/Objective:

Work with insurance companies where available for creditor's customers to determine the cause of denial or non-payment of a claim, initiate appropriate action required to prepare and submit documentation needed to resolve the denial or non-payment, follow up to the point of payment or exhaustion of recourse and maintain records in accordance with company policies and procedures. Continuously strive to provide a seamless interface for the consumer between BCA Financial Services, Inc. (BCA) and the creditor client

BCA Financial Services, Inc. is seeking detail-oriented full-time Insurance Claim Collectors with a minimum of 2 years medical insurance billing and claims follow up experience.

Benefits we offer:

• Monday through Friday schedule
• Medical, Dental, Vision, and Voluntary Life insurance
• 401k with a company match
• Paid time off and paid holidays

The Medical Insurance Collector will:

• Work with insurance companies to determine the cause of denial or non-payment of a claim.
• Initiate appropriate action required to prepare and submit documentation needed to resolve the denial or non-payment of a claim.
• Follow up to the point of payment or exhaustion of recourse and maintain records in accordance with company policies and procedures.

Essential Functions:

• Receive inbound and make outbound calls regarding insurance related matters and maintain clear and concise documentation of all attempts and/or contacts directly on the computerized collection system
• Research and analyze accounts by gathering records and examining historical data, using intuition and experience to compliment data with the goal of resolving obstacles to payment
• Verify insurance through a variety of mediums such as outbound phone calls and insurance websites to verify benefits
• Review assigned claims working within the established productivity standards for timely follow-up, maintain and update all accounts to reflect current information
• Perform appropriate account activity by contacting managed care, governmental and commercial insurance carriers to affect payment on claims
• Identify payor trends in payment delays and escalates issues to appropriate personnel
• Answer all inquiries from consumers promptly; attempt to resolve consumer concerns by inquiring as to specific issues and clarifying those issues
• Use relevant information and individual judgment to determine whether events or processes comply with company and client expectations as well as all relevant local, state and federal regulations
• Maintain established productivity standards and meet performance standards on a consistent basis
• Demonstrate a strong working knowledge of, and comply with, the Health Insurance Portability and Accountability Act (HIPAA) and all other statutes, laws and regulations pertinent to the collection industry as well as industries served

Requirements

Qualifications:

• High school diploma or equivalent
• Minimum of 2 years working in a healthcare revenue cycle environment with a concentration in the areas of insurance billing and collections
• Advanced knowledge of the healthcare insurance environment to include managed care, governmental and commercial insurance carriers as well as a myriad of reimbursement methodologies specific to provider contracts (fee schedule, per diems, percentage of total charges, etc.)
• Advanced awareness of the various codes used when filing health insurance claims. This position will not affect coding changes to claims but rather will understand coding requirements and communicate need for amendment of codes to creditor clients
• Knowledge of medical terminology and basic anatomy
• Effective interpersonal and human relations skills
• Effective verbal and written communication skills

Work from home requirements:

• Have a quiet and private workspace
• High speed internet with the ability to hardwire via 50 ft. ethernet cable from modem to your PC. Must be a sufficient speed to support video/web/audio and voice-over-IP (VoIP) (at least 20mbs download and 10mbs upload). Wi-Fi and hotspots are not supported.
• You must meet all the technical requirements prior to the first day of training
• You must live in one of the following states: FL, GA, MO, NE, NC, SC, TN, or VA.
• We will provide you with the equipment needed to be successful

BCA Financial Services, Inc. is an Equal Opportunity Employer and values diversity at all levels of the organization. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, age, disability, veteran status, genetic information, or any other legally protected status.

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