Maintains an environment of safety for patients, self and others.
Reviews, verifies, edits and submits/transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies in a timely, accurate and compliant manner.
Reviews third party payor payments, explanations of benefits/payments and other correspondence received to assure accurate processing has occurred. Initiates corrective action as indicated.
Obtains initial authorization and ongoing authorizations; negotiates rates; verifies patient eligibility/ co-pays and benefits; obtains payor requirements and policy restrictions and claim requirements.
Maintains current knowledge of federal and state claim processing regulations and third party payor contracts, including payment rates and claims processing requirements and determines how to appropriately file claims.
Researches, investigates and coordinates efforts with patients, third party payor organizations and internal staff to assure timely responses and action steps are taken in response to inquiries, questions or concerns.
Documents all claims processing, follow-up, collection, account inquiry resolution and reconciliation actions taken pursuant to departmental and hospital procedures.
Post Payments. Initiates appeals on appropriate denials in order to improve cash.
Communicates with insurance companies to obtain patient eligibility, benefits, co-pays, policy restrictions; obtains all billing requirements (type of bill, CPT codes); negotiate reimbursement rates with noncontracted vendors (if differs from set reimbursement rate, will go to Billing Manager); obtain all re-authorizations; communicate with Insurance case managers and staff regarding authorization information; enter all authorization information into patient file and maintain patient billing/authorization file updates.
High school diploma or general education degree (GED) and one year of office management in a health care setting. Computer skills required, with Microsoft Word and Excel experience preferred.
Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, federal, state and third party claims processing requirements and regulations and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.COMPUTER SKILLSAbility to use hospital and medical claims processing software. Working knowledge of Word, Excel, Schedule Plus, and Microsoft Exchange. Proficient keyboarding skills. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Rex is a king of health care in Raleigh. Part of the UNC HealthCare System, Rex Healthcare is a not-for-profit health care provider that...