Collections Claims Clerk

Job Description

Job Description

Collections Claims Clerk requires:

• Claims
• Collections
• V-lookup denials and action codes from denial log spreadsheet.
• Run query to pull in batch and check numbers associated with claims.
• Research credits to determine whether there are two payments applied to the claim or if there is an overpayment.
• Determine whether a refund is due to insurance or member.
• If there is a refund due, complete refund request. If there are two payments applied and one belongs to a different invoice, complete redirect.
• Open claims with no payment, nor denial, see resubmit instructions.
• If a claim has already been resubmitted and still neither payment, nor denial has been received, contact payer to check status of the claim and work towards a resolution.
• Once all actions have been determined, send write offs for approval to supervisor. For all write offs over $1000, they must be approved by finance manager.
• Identify trends within payers to find issues. If there is an issue within plan set up, forward it to be corrected. Work with payer relations and/or payer directly to resolve outstanding issues affecting payment.

• Complete all actions: write offs, resubmits, calls, e-mails and post V-lookup denials and action codes from denial log spreadsheet.
• Run query to pull in batch and check numbers associated with claims. Research in Filebound for additional denials.
• Research credits to determine whether there are two payments applied to the claim or if there is an overpayment. Determine whether a refund is due to insurance or member. If there is a refund due, complete refund request. If there are two payments applied and one belongs to a different invoice, complete redirect.
• Open claims with no payment, nor denial, see resubmit instructions.
• If a claim has already been resubmitted and still neither payment, nor denial has been received, contact payer to check status of the claim and work towards a resolution.
• Once all actions have been determined, send write offs for approval to supervisor. For all write offs over $1000, they must be approved by finance manager.
• Identify trends within payers to find issues. If there is an issue within plan set up, forward it to be corrected. Work with payer relations and/or payer directly to resolve outstanding issues affecting payment.
• Complete all actions: write offs, resubmits, calls, e-mails and post for auditing.