JOB SUMMARY: Responsible for insurance follow up and or appeals and contract management for Mountain View Hospital and Idaho Falls Community Hospital and Snake River Hospitalists.
Ensures claims are paid according to hospital contracts with payors, and will appeal claim if/when necessary to have them reprocessed and paid accordingly.
DUTIES AND RESPONSIBILITIES:
Insurance Denials/Appeals Clerk:
1.
Responsible for the timely follow-up and collections of all billed Commercial insurance accounts by running appropriate reports, utilizing online tools, and making contact with payers over the phone or online.
2.
Must be familiar with legal jargon and contract wording and have the abillity to apply that language to hospital encounters.
3.
Attention to detail and organization a must.
4.
Updates the patient account record to reflect the current actions that had been taken.
5.
Reviews EOB’s/payments and verifies that accounts are being paid according to contract.
6.
Sorts/files correspondence and maintains items in date order.
Responsible to work and follow-up on reminders daily.
7.
Processes non-clinical appeals on accounts when appropriate.
Sends requests to medical records as needed.
8.
Responsible for rebilling claims when required.
Responsible for contacting responsible party if additional information is requested for billing purposes.
Responsible for notifying insured of insurance denials.
9.
Processes denials from insurance EOB’s weekly.
10.
Identifies problem accounts as well as claims processing delays and escalates to management.
11.
Maintains various payers bulletins and educational updates in work area.
Attends/participates in all available educational opportunities to stay in compliance with insurance and government regulations.
12.
Maintains patient confidentiality at all times
13.
Responsible for knowing hospital policies and being familiar with hospital services.
Performs other job related duties as assigned by management.
The employee is required to comply with all PCI standards and other company policies and procedures for payment card acceptance and security.
Responsible for the timely follow up and collections of all billed, MCR, MCD and commercial insurance accounts by running appropriate reports, utilizing online tools, and making contact with payers over the phone or online.
Must be able to navigate and update Claim Source.
14.
Updates the patient account record to reflect the current actions that had been taken,
15.
Reviews EOB’s/payments and verifies that accounts are being paid according to contract.
16.
Sorts/files correspondence and maintains items in date order.
Responsible to work and follow-up on reminders daily.
17.
Processes non-clinical appeals on accounts when appropriate.
Sends request to medical records as needed.
18.
Responsible party if additional information is requested for billing purposes.
Responsible for notifying insured of insurance denials.
19.
Process denials from insurance EOB’s weekly.
20.
Identifies problem accounts as well as claims processing delays and escalates to management.
21.
Maintains various payers bulletins and educational updates in work area.
Attends/participates in all available educational opportunities to stay in compliance with insurance and government regulations.
22.
Maintains patient confidentiality at all times.
23.
Responsible for knowing hospital policies and being familiar with hospital services.
24.
Performs other job related duties as assigned by management.
25.
Responsible for the review of insurance payments to ensure claims are paid according to payor contracts.
26.
Additional Duties as assigned
QUALIFICATIONS:
Education/Certification: High school diploma or general education degree (GED).
CPC Certification is beneficial.
Experience: Minimum four years office experience or current employment in a related field preferred.
Familiar with billing forms UB04 and HCFA 1500 preferred.
Equipment/Technology: Ability to use hospital information system, and operate basic computer functions and software.
Language/Communication: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.
Ability to write routine reports and correspondence.
Ability to speak effectively before groups of customers or employees of the organization.
Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.
Ability to compute rate, ratio, and percentages and to draw and interpret bar graphs.
Mental Capabilities: Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form.
Ability to deal with problems involving several concrete variables in standardized situations.
Interpersonal: Ability to work well with others.
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