Hours: Monday-Friday 8:00am-4:30pm
Summary of Essential Functions
• Files insurance claims on the UB-04 and HCFA 1505 form for hospital and physician services.
• Computes insurance benefits, allowances, adjustments and patient balances.
• Processes tracers and verifies reimbursement from payers, and other payers as assigned.
• Displays positive customer relations with other departments within the hospital, patients, and insurance companies.
• High school graduate or equivalent.
• Over 1 year and up to 2 years’ experience, all of which may be obtained through vocational school or related job experience.
• Must be able to communicate effectively in English, both verbally and in writing.
• Knowledge in all areas of insurance, including but not limited, the ability to analyze and compile insurance billing data on the UB-04 and HCFA 1505 forms.
• Knowledge of the filing practices for all third party payers.
• Ability to compute insurance benefits, allowances, adjustments and patients balances.
• Knowledge of the appeal process to government payers, and other payers as assigned.
• Ability to analyze payment practices of governmental payers, and other payers as assigned.
• Knowledge of patient accounts and the ability to discuss account information with patients and insurance companies.
• Ability to read, comprehend and apply governmental rules and regulations.
• Ability to utilize tools available (i.e. payer websites).
• Ability to sit at a terminal for long periods of time.
• Lifting objects of no more than 15 pounds.
• Requires correctable vision and hearing to normal ranges.
• Requires the ability to distinguish letters and symbols.
Duties and Responsibilities
• Compiles data and prepares insurance claims for billing. Compiles data utilizing patient, hospital and insurance data and reviews LMRP queries to ensure proper processing. Reviews and corrects/posts appropriate adjustments to patient accounts. Investigates and corrects questionable charges to patient accounts.
• Reviews assigned insurance reimbursement and ensure correct account balance and generate appropriate secondary billing if applicable.
• Ensures claims are filed accurately on a daily basis utilizing billing processes. Properly applies the 24/72 hour regulations to ensure compliance.
• Processes tracers for hospital and physician claims ensuring timely filing to avoid missing deadlines.
• Verifies and calculates hospital and physician payments, follows up on incorrect payments or denials in a timely manner and ensures proper status of accounts. Notifies management of any consistent discrepancies or potential reimbursement problems.
• Processes daily reports, mail, e-mails and phone calls. Determine whether to re-file a claim, refund, or process an adjustment. Identifies Medicare and Medicaid combine messages on a daily basis. Responsible for obtaining proper assistance combining accounts.
• Processes email requests from other departments on a daily basis and responding in a timely manner as required. Non-billable report is worked on a daily basis ensuring adjustments are posted accurately and timely. All mail received is worked within 2 days of receipt and all information is documented in the patients account note file.
• Performs all other tasks/responsibilities as necessary.
**All qualified candidates apply today by sending in your resume to Stacie@mystaf.net net and apply NOW at MyStaf.net
If you are already registered, please call the office at (940)322-5588