Claims Processor I

Claims Processor I

Requirements

• High school diploma required
• One year of billing and insurance follow up in a hospital or physician office setting preferred
• Able to prioritize work on a daily basis
• Requires independent judgement in handling patient accounts
• General working knowledge of insurance terminology and billing rules
• Knowledge of Epic preferred

Responsibilities

• Updating registration, authorization issues, identifying charge correction, debit or credit memos, processing adjustments as needed and denial follow up according to payer rules and departmental policies
• Use electronic billing system appropriately to follow up on outstanding denied claims and all no response claims
• Correct claims in electronic billing system for missing or invalid insurance or patient information according to procedures
• Follow up on denied or no response claims by calling third party payers or using payer websites
• Gathering information from patients or other areas to resolve outstanding denied or no response claims
• Researching accounts to take appropriate action necessary to resolve
• Keep management aware of issues and trends to enhance operations and escalates slow-pay issues to managerial level when necessary
• Uses payer websites to stay current on payer rules and changes
• Maintains 90% quality standards on account follow and activity
• Maintains productivity standard as set forth by management team
• Other duties as assigned

Preferred Qualifications

• Knowledge of Epic preferred