Insurance Analyst

Job Overview Default Work Shift: Day (United States of America) | Hours: 40 | Salary range: $20.71 - $31.46 | Schedule: Full Time | Shift Hours: 8 Hour employee | Department: Patient Financial Services Job Objective Performs account review, follow‑up, and collections to include double recoupment, correspondence, and credit balance resolution. Assists leadership with setting and maintaining goals within the department, including redirecting assignments and targeting aged and outstanding issues. Provides guidance and training when needed. Education 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. Reports To Director of Patient Financial Services and/or Clinic Billing Skills, Knowledge, and Abilities Ability to handle multiple projects/tasks at the same time and prioritize workload. Ability to interpret payer contracts and reimbursement practices by payer and state by state regulations. Ability to operate basic office equipment (copiers, fax machines, calculators). Ability to support and train staff on insurance billing, collections policies/processes, system processes. Basic knowledge of ICD‑10, CPT, and HCPC coding. Effective communication, organizational, and problem‑solving skills. Excellent time management skills. Knowledge of computer‑based claims management and database systems. Knowledge of internet applications. Knowledge of managed care, Medicare/Medi‑Cal billing regulations. Knowledge of rules and regulations of third‑party payers. Knowledge of the Federal Fair Debt Collection Practices Act. Strong customer service and problem‑solving skills. Strong financial, mathematical, and analytical skills. Strong knowledge of contract reimbursement methodology and proration. Strong knowledge of medical terminology. Strong knowledge of Microsoft Office, voicemail, and Epic. Strong knowledge of payer contracts, interpretation, policies, and procedures. Strong Windows knowledge and keyboarding skills. Essential Responsibilities Demonstrate compliance with Code of Conduct and compliance policies, and take action to resolve compliance questions or concerns. Manage new accounts daily by working within Receivables Workstation and interfacing with other departments to obtain information necessary to process or resolve claims. Work all accounts listed in the Follow‑Up queue daily to promote collection of accounts, including telephoning payers and researching claims on payer web sites. Manage account inventory timely to promote payment and resolution of all accounts as instructed by management. Stay current on all payer requirements by reading bulletins, reviewing provider handbooks, and accessing websites. Process incoming correspondence, including signature letters, denials, prior authorizations, and additional information necessary to process the claim. Record newly identified insurance plans and facilitate the account processing of new plan in accordance with pre‑billing policies and procedures. Record accurate and definitive notes in the electronic account file that depict the current status of account, issues with account, and anticipated date of resolution. Escalate account management to Supervisor when issues arise. Ensure PFS management is kept up to date with contract, payer or system changes and issues. Assign a status code to each worked account to enable account tracking, statistical data gathering, and audit activities. Manage new credit balance accounts daily and prepare adjustments or refunds to zero the account balance. Handle special projects as directed by management (e.g., high dollar accounts, accounts over 180 days old). Maintain productivity standards by payer assignment. Review denial, payor rejection, and any other necessary reports to determine strategy in decreasing payor denials, clearing house rejections, and delayed payments. Manage commercial insurance, Medicare credits, and Medicare quarterly credit balance reports to ensure timely resolution of refunds and balance rectification. Manage priority account inventory in a timely manner to promote payment and resolution of all accounts as instructed by management. Regularly analyze account inventory aged greater than 90 days to promote payment and resolution of all accounts and decrease AR days. Provide analysis on aged inventory for future checks and balances and timely resolution to PFS Management Staff and Director. Process incoming hard copy explanation of benefits and react appropriately to resolve the accounts. Obtain and record “Promise to Pay” amounts daily that are consistent with the cash collection goals. Identify work unit issues and participate in solutions and problem solving with supervisor and staff members. Attend in‑house training and classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines. Participate in payer webinar and training sessions to maintain latest knowledge on billing, coding, and reimbursement practices; monitor updates with insurance payers and relay information to management, trainers, and co‑workers effectively. Perform other job‑related tasks as assigned. EEO Statement We are an equal opportunity employer and celebrate diversity. All employment decisions are made without regard to race, color, religion, sex, national origin, age, disability status, veteran status, or any other protected characteristic. #J-18808-Ljbffr