Insurance Claims Processor Responsibilities include following up on insurance claims, checking eligibility, handling medical denials and appeals. Additional duties include keeping track of multiple accounts, deadlines, identifying and correcting errors, documenting all calls timely and accurately, working correspondence and interpreting payer guidelines. Position supervisory responsibilities: Reports To: Billing/Collections Coordinator.
Supervises: None.
Position requirements:
Minimum education: High School graduate or equivalent. Minimum work experience: Up to one year's experience in a hospital, insurance or office environment. Prior experience involving public contact. Required licenses/certifications: None. Required skills, knowledge, and abilities: Knowledge of insurance requirements, regulations and billing guidelines, including Medicare, Medicaid, HMO, PPO and commercial policies. Knowledge of ICD-10 and CPT coding systems. Claims follow-up, denial resolution and appeals process. Analytical and critical thinking ability to diagnose account issues. Demonstrated professional conduct and meticulous attention to detail. Proficiency in Microsoft Office suite, especially Excel. Ability to operate office equipment, such as copy machines, fax machine and printers. Must be able to work independently with minimal supervision. Good communication skills essential.
Preferred qualifications:
Some college. Experience processing commercial and managed care claims. Experience with automated systems. Medical terminology.
Job specific functions:
Demonstrates an understanding of and adherence to the HMHD Compliance Plan.
Conduct reflects HMHD's values and a commitment to HMHD's Code of Conduct.
Attends the required corporate integrity and compliance training and education programs.
Demonstrates proficiency in understanding the materials presented during the corporate integrity and compliance training and education program.
Complies with all HIPAA standards.
Process and complete appeals within a timely manner.
Review incoming bulletins from governmental payers, and share with appropriate personnel.
Retrieve medical records from Healthport and mail to payer in a timely manner.
Complete follow-up on delinquent accounts by telephone, internet, or correspondence to resolve outstanding balances and to determine payment date.
Work in tandem with other departments i.e. HIM (Medical Records) to ensure that requests are complete.
Post recoups on a daily basis.
Contractuals reviewed and adjusted when necessary.
Reconciliation of payer remit after electronic posting to patient accounts.
Process and complete assigned bills within 48 hours of receipt.
Complete required Confirmation Acceptance Reports, and Transmittal reports on a daily basis.
Utilize current Age Trial Balance as a resource with a focus on accounts > 30 days in age.
Review and complete reminders consistently, and in a timely manner.
Follow-up on pending correspondence and other mail received within 72 hours of receipt.
Enter accurate and thorough comments on each patient account.
Resolve issues and/or concerns amicably in a timely manner. Involves PFS Leader when needed.
Promote and demonstrate excellent customer service at all times with internal and external customers to include patients, physicians, co-workers and all other customers.
Communicates effectively and expresses ideas clearly, actively listens and follows appropriate channels of communication.
Adaptable and responsive to change.
Uses time clock accurately and is punctual on a consistent basis.
Demonstrates a positive attitude in all assigned task and towards others.
Follows "Call-In" policy by notifying PFS Leader of absence.
Absences during evaluation period: 0-6 Occurrences = Meets Requirements. 7 or more Occurrences = Does not meet requirements.
Adheres to hospital and department dress code. Maintains a professional appearance at all times.
Consistently contributes to the achievement of excellence in healthcare through the quality and caring values of the mission and vision of Hunt Memorial Hospital District.
Perform special duties and projects as assigned.
