Account Analyst I (Biller - Collector)

Job Title

CC807100 PSO Professional Billing

Summary

Monday to Friday, 8:00 a.m. to 5:00 p.m. — Hybrid

Additional Information

Prepares accurate and complete medical claims/billings for timely submission to third-party payers. Responsible for follow-up and collection activities to assure prompt and proper payment from third-party payers. Responsible for knowledge of medical billing requirements and software products essential to performing job duties. Analyzes claims for payment. Resolves denials. Identifies problem trends and works to resolve.

Required Education

High school diploma or GED or equivalent

Recommended Education

Bachelor's degree in a related field of study.

Required Work Experience

High School Diploma/GED, or 2 years of experience in lieu of a diploma/GED.

Recommended Work Experience

Required Certifications

Recommended Certifications

Description

1. Analyzes medical claims to assure they are complete and accurate and have any required attachments before being filed to payer (clean claim). 2. Expedites proper adjudication of claims by payer to maximize reimbursement and minimize older age accounts. Identifies claims that have not been adjudicated and assures they are adjudicated promptly. Analyzes reason given for claim not being adjudicated and how we might overcome lack of adjudication. 3. Reviews adjudicated claims to assure they were properly adjudicated with the proper payment amount and to assure that unpaid amounts are valid and properly categorized. Appeals claims that are improperly adjudicated so they are promptly corrected. 4. Identifies problems and patterns, quantifies, reports and resolves problems. 5. Establishes effective working relationships with internal and external customers to expedite creation of clean claims and prompt and proper adjudication of claims. Communicates technical information accurately and effectively whether in writing or orally. Excellent ability to think on feet. 6. Performs other duties as assigned.