Insurance Analyst II-Patient Financial Services

Job Description:

Education:

Required: High school diploma, GED or higher level degree

Licensure/Certification:

N/A

Experience:

Required: Three (3) years of experience in medical billing or collections
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. This will include 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 Supervisor when issues arise, if needed.
• Ensures PFS management 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 management e.g. high dollar accounts, accounts over
• Maintains productivity standards by payer assignment.
• Reviews denial, payor rejection, and any other necessary reports to determine strategy in decreasing payor denials, clearing house rejections and delayed payments
• Manages Commercial Insurance, Medicare credits and Medicare quarterly credit balance reports to ensure timely resolution of refunds and balance rectification.
• Manages priority account inventory in a timely manner to promote payment and resolution of all accounts as instructed by management.
• Regularly analyzes account inventory aged greater than
• Provides analysis on aged inventory for future checks and balances and timely resolution to PFS Management Staff and Director.
• Processes incoming hard copy explanation of benefits and reacts appropriately to resolve the accounts.
• Obtains and records “Promise to Pay” amounts on a daily basis that are consistent with the cash collection goals.
• Identifies work unit issues and participates in solutions and problem solving by working with supervisor and staff members.
• Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.
• Participates in Payer webinar and training sessions to maintain latest knowledge on billing, coding and reimbursement practices; monitors updates with Insurance Payers and relays information to management, trainers and co-workers effectively.
• Performs other job related tasks as assigned.

Essential Skils:

• Knowledge of the Federal Fair Debt Collection Practices Act
• Strong knowledge of payer contracts, interpretation, policies and procedures
• Ability to support and train staff on Insurance billing, collections policies/processes, system processes
• Strong financial, mathematical and analytical skills
• Strong knowledge of Microsoft Office, voicemail and Epic
• Strong knowledge of contract reimbursement methodology and proration
• Knowledge of managed care, Medicare/Medi-Cal Billing regulations
• Strong knowledge of medical terminology
• Knowledge of rules and regulations of third party payers
• Ability to interpret payer contracts and reimbursement practices by payer and state by state regulations
• Ability to handle multiple projects/tasks at the same time and prioritize workload
• Effective communication, organizational and problem-solving skills
• Strong customer service and problem solving skills
• Basic knowledge of ICD-10, CPT and HCPC coding
• Ability to operate basic office equipment ie copiers, fax machines and calculators
• Knowledge of database system and experience with internet applications
• Excellent time management skills
• Strong windows knowledge and keyboarding skills
• Knowledge of computer based claims management