Under general supervision, reviews, corrects, completes and re-files all insurance claims with third party payers. Obtains confidential material that is necessary in the performance of assigned tasks. Keeps the manager informed as to the needs of the claims processing area and any problems that may arise.
ESSENTIAL JOB FUNCTIONS:
- Maintains knowledge of all facets of insurance claim filing, requirements and regulations and maintains files for reference with this information
- Maintain work queue in Claim IQ so that accounts are not delinquent
- Calls insurance companies inquiring about delayed insurance claims
- Identifies delayed insurance claims
- Posts any denials received from insurance companies
- Maintains an active file of authorizations, claim forms, and reports to file with insurance claims
- Processes, reviews, and makes corrections by Remote Entry System
- Attends in-service and required meetings as scheduled
- Researches information to complete any re-billing process
- Maintains established department policies, procedures and objectives
- Assists in the care and maintenance of department equipment and supplies and alerts supervisor to equipment malfunctions
- Assumes responsibility for all insurance claims being researched
- Practices the Standards of Service for the Health System
- Performs other duties as assigned by supervisor
EDUCATION, SKILLS & EXPERIENCE:
• Must have a high school diploma of equivalent.
EXPERIENCE, TRAINING, KNOWLEDGE:
• Knowledge of medical terminology and/or insurance claims filing experience is required. Hospital UB04 billing preferred.
CERTIFICATION, LICENSURE, BONDING: