Allowables Representative

Working Level

Full-Time

Job Category

Admin-Clerical, Administrative, Healthcare

External Job Title

Allowables Representative

Location

Remote

Marketing Location

Louisville, TN

Requirements

QUALIFICATIONS / EXPERIENCE:         Minimum High School diploma or equivalent;     Additional training in medical billing preferred;     Accounts Receivable experience preferred;     Knowledge of physician billing policies and procedures helpful;     Ability to understand and interpret ambiguous contract language;     Computer literate;     Able to work in a fast-paced environment;     Good analytical skills;     Good organizational skills;     Able to work independently;     Excellent oral and written communication skills;     Knowledge of CPT and ICD-10 medical coding guidelines preferred;     Strong data entry and 10-key skills;     Training classes and seminar attendance may require travel;     Regular and predictable onsite attendance;     High level of interaction and teamwork. SUPERVISORY RESPONSIBILITIES:     None PHYSICAL / ENVIRONMENTAL DEMANDS:     Job performed in a well-lighted, modern office setting     Occasional standing/bending     Occasional lifting/carrying (20lbs or less)     Some travel locally and overnight     Moderate stress     Prolonged sitting     Prolonged work on a PC/computer     Prolonged telephone work This position may require manual dexterity and/or frequent use of the computer, telephone, 10-key, calculator, office machines (copier, scanner, fax) and/or the ability to perform repetitive motions and/or meet production standards to comply with the essential functions. Also, may require physical and/or mental stamina to work overtime, additional hours beyond a regular schedule and/or more than five days per week. Overtime may be required and can be mandated by Management. DISCLAIMER: Cooperative, positive, courteous and professional behavior and conduct is an essential function of every position. All employees must be able to work with others beyond giving and receiving instructions. This includes getting along with co-workers, peers and management without exhibiting behavior extremes. Job functions may require personal leadership skills such as conflict resolution, negotiating, instructing, persuading, speaking with others as well as responding appropriately to job performance feedback from the supervisor. Additionally, the information contained in this job description has been designated to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to this position.  

External Job Description and Responsibilities

JOB DESCRIPTION OVERVIEW: The Allowables Representative is responsible for providing support to the Allowables Analyst to resolve underallowed claims. ESSENTIAL DUTIES AND RESPONSIBILITIES:  

• Runs specific payer underallowed reports for submission to carrier;
• Reviews payer overallowed reports to verify if the claims are truly over paid or over contractualized;
• May need to work with the Refund Department to verify the validity of an insurance refund request;
• Completes necessary appeals;
• Follows up on appeals and underallowed reports with carrier;
• Runs queries to monitor progress;
• Completes research form for submission to Managed Care department;
• Follows up with Managed Care on any delinquent requests;
• Consults with Allowables Analyst for unusual circumstances that may include system data issues, payer responses, Managed Care delinquencies;
• Other duties as directed by management.

Career Builder

Yes

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