Insurance Analyst I-Clinic Billing Services

Job Description:

Education:

Required: High school diploma, GED or higher level degreeRequired: High school diploma, GED or higher level degree Licensure/Certification: N/A Experience: Required: One (1) year of billing/collections experience, billing certification or prior successful internship/temporary assignment in a patient financial service setting
Preferred:

Licensure/Certification:

N/A

Experience:

Required: One (1) year of billing/collections experience, billing certification or prior successful internship/temporary assignment in a patient financial service setting
Preferred: Experience with managed care and Medicare/Medi-Cal Billing regulations

Essential Responsibilities:

• Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
• Manages new accounts, on a daily basis, by working within Receivables Workstation; interfaces with other departments within the hospital, when appropriate, to obtain information necessary to process or resolve claims; contacts patient and/or account guarantor to solicit payment on account.
• Works all accounts listed in the Follow-Up queue on a daily basis to promote collection of accounts; includes telephoning the payer, messaging or identifying the claim on the payers’ Internet websites.
• Manages account inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.
• Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.
• Processes incoming correspondence, including signature letters, denials, prior authorizations and additional information necessary to process the claim.
• Records newly identified insurance plans and facilitates the account processing of new plan in accordance with pre-billing policies and procedures.
• Records accurate and definitive notes in the electronic account file that depict the current status of account, issues with account and anticipated date of resolution.
• Escalates account management to leadership when issues arise, if needed.
• Ensures leadership is kept up to date with contract, payer or system changes and/or issues.
• Assigns a status code to each worked account to enable account tracking, statistical data gathering and audit activities.
• Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance.
• Handles special projects as directed by leadership e.g. high dollar accounts, accounts over
• Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.
• Maintains productivity standards by payer assignment.
• Performs other duties as assigned.

Essential Skils:

• Ability to interpret payer contracts and federal and state regulatory guidelines
• Ability to prioritize tasks and manage time efficiently to meet deadlines
• Ability to handle multiple projects/tasks at the same time and prioritize workload
• Strong customer service and problem solving skills
• Knowledge of Medical Terminology
• Ability to operate basic office equipment ie copiers, fax machines and calculators
• Knowledge of database systems and internet applications
• Strong windows knowledge and keyboarding skills
• Knowledge of computer based claims management