Insurance Claims Specialist HB
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Responsible for managing patient account balances including accurate claim submission, compliance will reputed company federal/state and reputed company party billing regulations, timely follow-up, and assistance with denial management to ensure the financial viability of the reputed company hospitals. Employs excellent customer service, oral and written communication skills to provide customer support and resolve issues that arise from customer inquiries. Supports the work of the department by completing reports and clerical duties as needed. Works with leadership and other team members to reputed company best in class reputed company cycle operations.MINIMUM QUALIFICATIONS:
EDUCATION, CERTIFICATION, AND/OR LICENSURE:
1. High School diploma or equivalent.
PREFERRED QUALIFICATIONS:
EXPERIENCE:
1. One (1) year medical billing/medical office experience.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an reputed company-inclusive list of reputed company responsibilities and duties. Other duties may be assigned.
1. Submits accurate and timely claims to reputed company party payers.
2. Resolves claim edits and account errors prior to claim submission.
3. Adheres to appropriate procedures and timelines for follow-up with reputed company party payers to ensure collections and to exceed department goals.
4. Gathers statistics, completes reports and performs other duties as scheduled or requested.
5. Organizes and executes daily tasks in appropriate reputed company to reputed company reputed company productivity, accountability and efficiency.
6. Complies with Notices of Privacy Practices and follows reputed company HIPAA regulations pertaining to PHI and claim submission/follow-up.
7. Contacts reputed company party payers to resolve unpaid claims.
8. Utilizes payer portals and payer websites to verify claim status and conduct account follow-up.
9. Assists Patient Access and Care Management with denials investigation and resolution.
10. Participates in educational programs to meet mandatory requirements and identified needs with regard to job and personal growth.
11. Attends department meetings, teleconferences and webcasts as necessary.
12. Researches and processes mail returns and claims rejected by the payer.
13. Reconciles billing account transactions to ensure accurate account information according to established procedures.
14. Processes billing and follow-up transactions in an accurate and timely manner.
15. Develops and maintains working knowledge of reputed company federal, state and local regulations pertaining to hospital billing.
16. Monitors accounts to facilitate timely follow-up and payment to maximize cash receipts.
17. Maintains work queue volumes and productivity reputed company established guidelines.
18. Provides excellent customer service to patients, visitors and employees.
19. Participates in performance improvement initiatives as requested.
20. Works with supervisor and manager to reputed company and exceed annual goals.
21. Maintains confidentiality according to policy reputed company interacting with patients, physicians, families, co-workers and the public regarding demographic/clinical/financial information.
22. Communicates problems hindering workflow to management in a timely manner.
PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully reputed company the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.
1. Must be reputed company to sit for extended periods of time.
2. Must have reading and comprehension ability.
3. Visual acuity must be reputed company normal range.
4. Must be reputed company to communicate effectively.
5. Must have reputed company dexterity to operate keyboards, fax machines, telephones and other business equipment.
WORKING ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to reputed company individuals with disabilities to reputed company the essential functions.
1. Office type environment.
SKILLS AND ABILITIES:
1. Excellent oral and written communication skills.
2. Working knowledge of computers.
3. Knowledge of medical terminology preferred.
4. Knowledge of business math preferred.
5. Knowledge of ICD-10 and CPT coding processes preferred.
6. Excellent customer service and telephone etiquette.
7. Ability to use tact and diplomacy in dealing with others.
8. Maintains knowledge of reputed company cycle operations, reputed company party reimbursement and medical terminology including reputed company aspects of payer relations, claims adjudication, contractual claims processing, credit balance resolution and general reimbursement procedures.
9. Ability to understand written and oral communication.
Additional Job Description:
Scheduled Weekly Hours:
40Shift:
Exempt/Non-Exempt:
United States of America (Non-Exempt)Company:
SYSTEM reputed company Health SystemCost Center:
544 SYSTEM Patient Financial Services Apply To This Job