The Insurance Review Clerk works to ensure that all medical procedures are properly filed with the appropriate insurance agency. Insurance Review Clerks review collected information from offices to verify the accuracy and completeness of information on claims forms, review related insurance documents provided by the patient, as well as review medical records to verify all relevant information. The Insurance Clerk works extensively with private insurers, as well as federal agencies such as Medicare and Medicaid, so they must remain current with all of the rules and regulations that govern third party payment for medical services.
- Review relevant documents provided by the patient and Holston Medical Group offices to ensure maximum reimbursements
- Review medical documentation provided by physicians and other health care providers in order to obtain detailed information regarding patients’ disease, injuries, surgical operations and other procedures as needed
- Perform “claim scrubs” to ensure the claims are processed on initial submission to the insurance companies the first time they are sent through correctly to the insurance companies the first time they are sent through
- Run various cues categorized by delinquency to diagnose reason for non payment
- Conduct quality review through report generation/ analysis as needed to determine completeness and legibility of claims
- Run the edit review report on denied claims to submit to insurance companies
- Pull internal accounts and attach employment of benefits (EOB’s) and charge number to draw up refunds for assigned Holston Medical Group physician
- Respond to patient and insurance mail correspondence to resolve notated issues and expedite payment
- Post insurance payments to appropriate accounts as needed
- Electronically file or paper file all medical procedures as appropriate for the assigned insurance type
- Handle all department phone calls regarding claims and patient account balances
- Open and review all department emails from Holston Medical Group offices to make corrections and ensure charges are accurate
- Remain abreast of changing insurance practices, laws and guidelines
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of personnel so classified.
- High School diploma or equivalent required
- Knowledgeable of insurance practices and guidelines
- Knowledgeable of billing practices, clinical policies and procedures
- Experience in coding and medical terminology
- Strong computer skills and ability to concentrate
- 0-2 years experience in healthcare
At Wellmont Health System, wellness is paramount. Wellmont Health System provides general and advanced medical-surgical care to residents of...