Position Title: Claims Analyst
FLSA Status: Hourly
Type of Position: Full-time
Department Name: Client Management
Reports To: Revenue Cycle Manager
The Claims Analyst is responsible for the submission of clean and timely patient claims to commercial, Medicare and Medicaid insurance companies.
ESSENTIAL FUNCTIONS OF THE JOB
- Review assigned reports and correct claims that are on hold or rejected. Note accounts as appropriate.
- Review system reports to identify delinquent accounts.
- Perform insurance verification to determine coverage and benefit eligibility of patient.
- Follow up with insurance to identify reason for non-payment. Take the appropriate and necessary action to have the claim paid.
- Respond promptly to inquiries, concerns and problems related to billing.
- Maintain a positive dialogue and collaborative working environment.
- Maintain thorough and detailed knowledge of medical fee schedules and reimbursement rules for numerous states including but not limited to Florida, Kentucky, Missouri, and North Carolina.
- Exhibit an understanding of federal, state and contractual guidelines/regulations as it relates to Medicare, Medicaid, Managed Care, and Commercial Insurance companies to ensure ongoing compliance.
- Demonstrate thorough knowledge of UB and 1500 electronic and hardcopy billing forms, formats, and filling requirements.
OTHER DUTIES AND RESPONSIBILITIES OF THE JOB
- Exhibit an understanding of CPT, HCPCS, Revenue Codes, ICD-10 diagnosis and procedure coding guidelines.
- Knowledge of HIPAA rules and regulations.
- All other duties as assigned.
SKILLS AND ABILITIES
- Preferred knowledge of medical terminology, CPT/HCPCS/UB04 revenue coding, modifiers, and billing regulations, documentation standards, fee schedules, third party billing and documentation standards.
- An overall knowledge of functions & activities of medical offices/hospitals, understanding of compliance, knowledge of various payment systems, skill in researching and resolving problems and issues
- Strong computer skills with knowledge of Microsoft Outlook, Word, Excel and practice management systems.
- Excellent interpersonal skills and experience interacting with personnel (clinical staff and finance/management/administration).
- Excellent written and oral communication skills.
- Strong team player.
- Adherence to strict confidentiality.
- Able to plan, analyze and prioritize workload.
- Meet deadlines and function independently.
- Three (3) to Seven (7) years’ experience in medical claims submission, follow-up, and correction for multiple payors and claim types for a Federally Qualified Health Center, preferably in Florida, Kentucky, and North Carolina.
- Experience across multiple practice management systems, clearinghouses, and payers strongly preferred.
EDUCATION / CERTIFICATION REQUIREMENTS
- High School Diploma or GED equivalent required.
- Coding Certification a plus.
PHYSICAL REQUIREMENTS ESSENTIAL TO PERFORM THE DUTIES OF THE JOB
- Frequently remains in a sitting position at a desk to perform duties.
- Frequently communicates with co-workers, customers, and contractors/vendors in person, on the telephone, and on the computer.
- Frequently works in a well-lit room.
- Frequently views the computer to perform duties.
- Frequently uses the computer with fingers and hands for documentation and communication.
- Occasionally stoops, bends, or kneels.
- Occasionally exposed to outside elements when traveling for business.
- Occasionally required to push and/or pull objects.
- Occasionally lifts and/or carries objects weighing up to twenty (20) pounds.
- Competitive salary and incentive bonus commensurate with experience along with Fortune 500 level benefits.
To apply send your resume to email@example.com.