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.
Main Responsibilities:
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
Disclaimer:
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.
Education/Experience/Knowledge:
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
Holston Medical Group - 30+ days ago
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