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 time-frames.
Responsible for editing and adjudicating 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.
UB Claim form
CPT, ICD-9 Volumes 1,2,3 and HCPCS coding
Revenue centers associated iwth billing
Hospital, ambulatory surgery center, home health, skilled nursing and dialysis claims
Division of Financial Responsibilities (DOFR)
Understanding of Stop Loss