Complete processing of hospital medical claims including adjudication and accuracy.
Accurately process institutional (hospital) claims.
Accurately process claims billed on UB04 claim form.
Maintaining/meeting compliance timeframes.
Responsible for editing and adjusting claims.
Analyze claims to ensure accurate billing and payment.
Interpret contracts and fee schedules.
Meet department accuracy and production standards.
Interface with other departments to obtain necessary information required for resolution of claims.
Understanding of health plan/industry compliance guidelines.
Working knowledge of the following:
- UB claim form
- CPT, ICD-9-Volumes 1, 2, 3 and HCPCS coding
- Revenue centers associated with billing
- Hospital, ambulatory surgery center, home health, skilled nursing and dialysis claims
- Division of Financial Responsibilities
- Understanding of stop loss