Medcloud’s Medical Collectors have the primary responsibility of reviewing all insurance claim determinations and take all further steps necessary to satisfy payment including but not limited to corrections, insurance appeals, and/or negotiate the claim.
Duties include, but are not limited to:
- Reviews insurance correspondence and identifies, reports and responds to overpayment requests and recoupments
- Negotiates settlement offers from Third Party Negotiation companies to expedite payment and circumvent the appeal process
- Identifies and processes anti-assignment payments per protocol
- Deals directly with the third-party administrator, insurance carriers, and workers comp. adjusters to successfully perform redeterminations.
- Uses internal software for filing appeals (both ERISA, and non-ERISA) to insurance carriers and employer groups stating a sound case as to why there should be additional reimbursement on a medical service performed
- Performs other charged responsibilities include dealings with the insurance companies to verify eligibility and benefits, assignment/anti-assignment, disputing patient coverage and following up on appeals, negotiations and redeterminations
- Review tasks daily to assure all account that require additional follow up get completed
- Clears assigned correspondence daily.
- Prepares accounts for external review, as needed.
- Assists with related special projects, as required.