Claims Processor I-5

Claims Processor I-5

Requirements

• High school diploma required
• One year of billing and insurance follow up in a hospital or physician office setting preferred
• General working knowledge of insurance terminology and billing rules
• Knowledge of Epic preferred

Responsibilities

• Account maintenance: Updating registration, authorization issues, identifying charge correction, 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. Corrects claims in electronic billing system for missing or invalid insurance or patient information according to procedures, and places account on hold if you can’t resolve.
• 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 to include reading newsletters and communicating payer/claim issues and trends.
• Maintains 95% quality standards on account follow and activity.
• Maintains productivity standard as set forth by management team.
• Other duties as assigned.

Preferred Qualifications

• One year of billing and insurance follow up in a hospital or physician office setting preferred
• Knowledge of Epic preferred