Revenue Cycle Claims Analyst
Essential Duties and Responsibilities:
- A complete understanding of assigned Insurance companies is required; their policies, guidelines and contracts.
- Prepares insurance primary and secondary claims for paper or electronic submission; ensures that necessary supporting documentation including patient signatures, referral forms & EOBs are submitted with claims if required.
- Confirms eligibility and coverage conditions on patient insurance when indicated.
- Audits all 'unbilled' claims for assigned insurance carriers for accuracy in charges/diagnosis & adherence to various insurance guidelines.
- Audits account balances and aging reports for assigned carriers; identify and take action on accounts which are in arrears following established protocols.
- Responds to all correspondence received from assigned insurance carriers in a timely manner.
- Utilize Insurance websites and phone to obtain status of claims and resolve denial/appeal issues.
- Identify, Analyze and escalate denial/appeal trends and keep Team Leader informed.
- Identifies under and over payment across financial classes according to established contracts.
- Creates and maintains carrier processes and guidelines. Keeping the Team Lead abreast of updated carrier policy.
- Assists patients who need explanation of their accounts.
- Maintains appropriate records pertaining for patient accounts and insurance reimbursement and correspondence.
- Works with a sense of urgency with regard to assigned work.
- Promotes a positive work attitude fostering teamwork and acceptance of management decisions.
- Additional duties may be assigned depending on department needs.
- Accountability- Takes responsibility for outcomes of personal actions, decisions, and behaviors. Provides consistent, timely, high quality work. Completes work by established time lines and routinely uses time effectively. Meets annual mandatory education and employee health requirements in the time frame prescribed. Is punctual, observes prescribed work hours and meal periods and has an acceptable overall attendance record. Adheres to safety guidelines and reports environmental issues to Facilities.
- Adaptability- Accepts and effectively adapts to changes in position, department and organization. Responds to change positively with a genuine desire to support the organization and accepting work assignment adjustments as needed.
- Communication- Communicates clearly and effectively both orally and written. Demonstrates active listening and respect for other's ideas, problems, and suggestions. Responds in a prompt and friendly manner to requests and inquiries. Respects confidentiality and is HIPAA compliant in all aspects of communication regarding patients, employees and the organization. Utilizes C.L.E.A.R. and H.E.A.R.T.
- Computer Literacy- Uses computers and software relevant to position effectively and efficiently in the working environment.
- Customer/Patient Focus- Knows the customer (internal and external) business needs and acts accordingly. Provides consistent, quality service to all patients and customers.
- Job Knowledge/Technical Skill- Effectively performs essential job functions on a consistent basis. Demonstrates the practical and technical skills and knowledge required for the job. Demonstrates initiative consistent with job expectations to improve performance.
- Professionalism- Takes pride in presenting a professional image and behavior. Maintains professional appearance by adhering to dress code and wearing identification badge. Acts in accordance with the Core Values.
- Teamwork/Cooperation- Creates a positive work environment and influences the behavior of other employees by their supportive and positive approach to daily activities within the work environment. Assists coworkers in response to fluctuations in workloads. Maintains positive work relationships by being courteous and respectful. Builds trust and works with integrity. Accepts criticism, is open to new ideas, and handles conflict constructively and diplomatically.
- High School Diploma/GED or related work experience necessary to perform the necessary business office functions.
- Some post-secondary education with emphasis in Business, Mathematics or Accounting helpful but not essential.
- Knowledge of insurance plans, member eligibility, and medical billing
- Background in claims processing and reimbursement preferred.
- Basic understanding of CPT, ICD-10 and HCFA.
- Excellent interpersonal and customer service skills
- Detail oriented
- Strong problem solving, research and analytical skills
- Excellent math, verbal and communication skills
- Computer proficiency