Insurance Claims Tracer I

Job Title

Collection of assigned outstanding insurance claims.

Exhausts all possible resources in collection efforts, including but not limited to phone calls to patients and insurance companies and written collection efforts.

Displays positive customer relations with other departments within the hospital, patients, and insurance companies.

Work from home available after 60-90 days of on-the-job training.

Educational Requirements

High school graduate or equivalent.

Previous experience in insurance is helpful which may be obtained through vocational school or related job experiences, 1 to 2 years preferred.

Insurance and medical terminology are helpful.

Must be able to communicate effectively in English, both verbally and in writing.

Certification/Knowledge/Skills/Abilities:

Requires the use of office equipment such as computer terminals, telephones and telephone headsets, copiers, 10-key adding machine, and fax machine.

Ability to communicate with others effectively and courteously.

Knowledgeable in all areas of insurance, demonstrate tact, diplomacy, and persistence required in daily contact with patients and third-party payers.

Must be able to prioritize collection efforts and work according to oral and written instructions using good organizational skills and sound judgment.

Demonstrate diligence, patience, and persistence to obtain required information on outstanding accounts.

Type 45 w.p.m. ensuring correct spelling and grammar when documenting account actions or written communications.

Basic mathematical knowledge including understanding of debits and credits for correct account transactions.

Ability to utilize tools available (i.e., payer websites).

Must have internet access and a secure office space to work from home.

Physical Requirements

Ability to work under pressure and stress and to sit at a terminal for long periods of time.

Required to lift objects of no more than 15 pounds.

Requires eye-hand coordination and manual dexterity to include correctable vision and hearing to normal ranges.

Must distinguish between letters, numbers, and symbols. Requires most work hours viewing of screens and keyboard entry on computer system.

Duties and Responsibilities

Compiles appropriate data based on insurance payer requirements for accurate follow-up.

Utilize accurate time frames assigned by management to ensure prompt follow up for reimbursement. Follows written and oral procedures to ensure prompt reimbursement.

Converse with third party payers efficiently and professionally to determine status of claims. Ensure accurate information is relayed to the payer to identify the claim.

Submit written and verbal inquiries to payers in an efficient and professional manner to determine status of claims. Ensure accurate information is included for the payer to identify the claim.

Demonstrate diligence and persistence with payers while maintaining tact and diplomacy.

Supply payers with requested information for the claim to be processed in a timely manner. Document all information pending from other providers. Follow through on all resources by contacting other providers and inform them of pended claim due to their outstanding claim information. Contacts patients as needed for required information.

Ensure all pertinent information is documented in the patient account note file. Ensure names and phone numbers are documented when applicable. Ensures correct insurance information is maintained and makes changes when necessary.

Refer accounts to assigned agencies contracted for insurance collection based on written and oral instructions. Refers to patient collections when efforts are exhausted.

Keeps informed on managed care contracts. Reads, retains, and utilizes processes to ensure notification of denial of discounts when appropriate. Sends appropriate correspondence.

Ensures work queues are reviewed and worked according to expectations.

Maintains good working relationships with coworkers and revenue cycle departments.

Maintains productivity set forth by department standards.

Performs all other tasks/responsibilities, as necessary.