Claims Processor

Responsible for the preparation and submission of all claims (electronic and CMS 1500 formats) to insurance payers. Retrieves and processes all ANSI-837 transmission reports, claim confirmation reports and claim rejection or suspense reports. Works closely with Charge Code analyst for claim correction, resubmission and/or appeals. Responsible for all aspects of the AR including patient AR, Insurance AR, denials and appeals.

Employment Type: Full-time

Shift: Mon-Fri 8a-4:30p

Weekly Scheduled Hours: 40

Wage range: $23.30-$34.95

Weekend Frequency: N/A

Requirements:

• High school diploma/GED or higher education
• Certified Coding Specialist (C-CCS) or Certified Professional Coder (CPC)

Claim Submission:

• Each day, retrieves, reviews, edits and submits/transmits all electronic direct ANSI-837, claims clearinghouse and paper claims.
• Submits all claims generated by the end of the business day.
• Achieves an error rate not to exceed 2% of claims submitted.
• Locates and retrieves all ANSI-837 final bill files for review and editing to achieve submission of "clean claims" to payors.
• Identifies all technical information that would prevent the claims from passing the payor "front-end" edits the first time submitted.
• Corrects all errors on the ANSI-837 transaction file, clearinghouse file, and/or paper claims and makes corresponding corrections in eClinical Works.
• Reports/documents errors and informs Billing Coordinator/Manager of recurring or high volume errors.
• Investigates and resolves any discrepancies between the transmission and acceptance files by the end of the business day.

IS Systems:

• Navigates efficiently within the practice management system.
• Maintains a thorough knowledge of the various computer systems and programs.
• Reviews and releases claims daily for batch submission or patient statements.
• Responsible for staying current with payor websites, correspondence/communication and other coding reference material.
• Maintains a high level of proficiency in the billing and coding guidelines, policies and procedures for the various payors.
• Utilizes the practice management system efficiently and accurately updates and edits information in eClinical Works.
• Reviews clearinghouse eligibility verification and payor websites for confirmation of active coverage.
• Submits claims on a daily basis for consistent revenue management.

Accounts Receivable:

• Follow up for Insurance and Patient Balances Identifies billing errors and resubmits claims when needed.
• Verifies all patient pay balances and confirms insurance eligibility prior to assigned to member.
• Identifies any discounts (self-pay, hardship, VFC) and communicates that to members as appropriate.
• Works AR trial balance reports and/or buckets monthly by payor for claims corrections and rebilling.
• Arranges and monitors payment plans for customers as needed.
• Recommends to appropriate staff refunds when necessary to members and/or payors.
• Maintains clean AR for all practices with explanations for leadership for outstanding items.

Customer Service:

• Receives and processes incoming phone calls as assigned.
• Identifies customer concerns and/or complaints and strives to fine "first-call resolution" whenever possible.
• Responsible to complete all follow-up required to resolve a request, to the satisfaction of the customer.
• Retrieves and process voicemail messages within one business day.
• Maintains a professional and private environment with the customers.
• Ensure patient confidentiality while protecting the patient rights and privacy.
• Notifies Billing Coordinator/Manager immediately of any issues or concerns that haven't been resolved.

Holland Hospital is an Equal Opportunity Employer, please see our EEO policy