Full-time Claims Analyst-Patient Accounting

Hours: 1st shift, Mon-Fri | No Supervisory Responsibilities | No Travel | Pay commensurate with experience Full time, day shift in Patient Accounting.

JOB SUMMARY

The Claims Analyst is responsible for tracking, reviewing and following up of all outstanding patient claims. The follow-up includes researching denials and rebilling when appropriate until all payments have been remitted by payors. This includes a timely review of account reminders. Claims Analyst contacts payors, files primary, secondary, and tertiary insurance, rebills, and reviews payment remittances. Reviews denials and claim rejections for possible appeal and/or research for resubmission, ensuring accuracy, compliance with regulations, and proper reimbursement. This role supports the financial integrity of the hospital by identifying discrepancies, preventing fraud, and optimizing claims workflows. Must be proficient in the use of multiple payor software systems and possess knowledge of billing coding, including CPT, ICD10, HCPCS, modifiers, CCI edits, MUE edits, and claims formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payors to ensure maximum cash flow. Interacts with patients and staff in a professional manner, promotes teamwork, and creates an environment where a positive patient experience is a requirement.

ESSENTIAL FUNCTIONS

Teams with the leadership to ensure that system deficiencies are eliminated through claim checks, dictionary changes/updates (if applicable), and/or service requests. Actively participates in ensuring that processes are effective and efficient and prevents minimizing the likelihood of denials. Follow up with third-party payors on unpaid claims until claims are paid or only true self-pay balances remain. Research rejections and denials, rebill corrected claims. Forward claims for additional appeals or reconsiderations to appropriate team members. Prepares and submits secondary and tertiary claims to payors for payment either electronically or via paper per the payor’s requirements. Keeps updated on all third-party billing requirements including HMP/PPO, Medicare, and Medicaid. Maintains confidentiality. Supports the hospital and promotes a positive attitude. Adheres to dress code, appearance is neat and clean. Wears identification while on duty. Must be willing to receive all required vaccinations (i.e., flu shot, etc.). All new employees working must be fully vaccinated as a condition of employment (unless the new hire has requested and received an exemption). Candidates for employment will be notified of this policy requirement prior to the start of employment. After receiving an offer of employment, new employees must provide proof of vaccination or request and receive an exemption before beginning work.

QUALIFICATIONS

Education: High school diploma or general education degree (GED) required. Post high school courses in insurance billing, data processing, and medical terminology preferred. Experience: 1 year of experience in computerized third-party billing of facility and/or professional services required. Knowledge of third-party billing requirements required. 2 years of previous hospital business office experience preferred. 1 year of experience with Meditech and/or SSI preferred. License/Certifications: N/A

ADDITIONAL INFORMATION

Benefits apply the 1st of the month following employment, per policy. Criminal background check and pre-employment drug screen required upon conditional job offer. Ashe Memorial Hospital is an equal opportunity employer and, as such, considers individuals for employment according to their abilities and performance. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care. Employment decisions are made without regard to race, age, religion, color, sex, national origin, physical or mental disability, marital or veteran status, sexual orientation, genetic information, or any other classification protected by law. All employment requirements mandated by local, state, and federal regulations will be observed. #J-18808-Ljbffr Ashe Memorial Hospital