Medical Claims Analyst
3 hours ago
Job Purpose
- Follow-up with payers to ensure timely resolution of all outstanding claims, via phone, emails, fax or websites.
- Meets and maintains daily productivity/quality standards established in departmental policies.
- Uses the workflow system, client host system and other tools available to them to collect payments and resolve accounts.
- Adheres to the policies and procedures established for the client/team.
- Knowledge of timely filing deadlines for each designated payer.
- Performs research regarding payer specific billing guidelines as needed.
- Ability to analyze, identify and resolve issues causing payer payment delays.
- Ability to analyze, identify and trend claims issues to proactively reduce denials.
- Communicates to management any issues and/or trends identified.
- Initiate appeals when necessary.
- Ability to identify and correct medical billing errors.
- Send appropriate appeals, accurate requesting information, supporting documentation, and effective communication to complete recovery process.
- Understanding of under or over payments and credit balance processes.
- Assist with special A/R projects as needed. Analytical skills and the ability to communicate
- results are required.
- Act cooperatively and courteously with patients, visitors, co-workers, management and clients.
- Use, protect and disclose patients' protected health information (PHI) only in accordance with
- Health Insurance Portability and Accountability Act (HIPAA) standards.
- Work independently from assigned work queues.
- Maintain confidentiality at all times.
- Maintain a professional attitude.
- Other duties as assigned by the management team
Qualifications
- Completed at least High School education
- With minimum 1 year of Healthcare Account Receivable/Collections in a BPO setting or environment (claims payments processing, claims status and tracking, Medical Billing, AR
- Follow ups, Denials and Appeals-outbound healthcare providers)
- Experienced on medical billing/ AR Collections.
- Background in calling insurance (Payer) to verify claim status and payment dispute.
- Must be amenable to work night shifts
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