Careers at APT

Claims Resolution Specialist

The Claims Resolution Specialist provides Advanced and Preferred Physical Therapy with services to ensure all claims are submitted timely to insurance and that follow up work is done as needed. This would include, but not be limited to, following up with insurance carriers on unpaid or rejected claims, ensuring claims can be submitted via our electronic clearinghouse, and posting insurance and patient payments in order to manage accounts properly. Responsible for ensuring all claims and accounts are treated as if they were our own and worked timely and efficiently while maintaining excellent customer service aiding in our patients’ overall satisfaction.

ROLES AND RESPONSIBILITIES

ROLE #1: Insurance Claims (40%)

Responsibilities:

  1. Insurance Coverage
    1. Verify active coverage
    2. Determine allowable benefits and compensation
  2. Follow up
    1. Resolve issues for unpaid or reduced claims
    2. Compile reports regarding the status of claims
    3. Submit medical records to insurance carriers
    4. Submit notes, scripts, referral or primary EOB
  3. Appeals
    1. Submit first and second level via paper or online
    2. Follow up with processing after appeal is submitted
    3. Request for reprocessing
      1. Referral and authorization on file
      2. Wrong information on the claim
  • Claim is denying for duplicate due to different cases

ROLE #2: Research & Tasks (30%)

Responsibilities:

  1. Documentation Change
    1. Voiding procedure codes that have been submitted
    2. Submit corrected claims
    3. Payer mix change
    4. Diagnosis change
  2. Resubmit Claims
    1. Modifiers
    2. Procedure Codes
    3. Functional limitation codes
    4. Diagnosis
    5. Co-signers
  3. Denied/Incomplete Reports
    1. Filter and Sort 0-45 days old
    2. Call payer, adjuster or check the website for status of the claim
    3. Claims listed must be researched at least once a month

 

ROLE #3: Clerical (30%)

Responsibilities:

  1. Phone Calls & Fax
    1. Patient questions about billing and insurance processing
    2. Clinic staff with questions about insurance coverage
    3. Insurance company correspondence through fax
  2. Zirmed
    1. Run patient credit card payments
    2. Fix incomplete patient information for electronic filing

 

Total of all roles = 100%

 

QUALIFICATIONS

  • High School Diploma
  • Experience in medical billing and coding preferred
  • Ability to work independently
  • Aptitude and solid capability with Microsoft Office platform (Excel, Word, Powerpoint, etc.)

 

Locations Hiring

Corporate Office

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