Claims Analyst Specialist is knowledgeable of all payers. Responsible for the tracking, review and follow-up of all outstanding patient accounts. This includes but is not limited to timely review of Patient Accounting Desktop, Clearinghouse billing list and Intermediary on line error list. Contact insurance companies and patients, filing primary, secondary and tertiary insurance, re-bills, and review payment remittance. Review line item denials and claim rejections for possible appeal and/or research for resubmission. Be proficient in the use of multiple payer software systems. The knowledge of billing codes including CPT, ICD10, HCPCS, Modifiers, CCI Edits, MUE Edits and claim formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payers to ensure maximum cash flow. Additional responsibilities include posting payments and denials to claims filed directly to a patient’s account via electronic posting and manual batch posting. Also required to process requested adjustments, complete daily reconciliation of bank deposits and payment posting. The Claims Analyst Specialist is responsible for entering daily posting numbers to accounting shared spreadsheet, processing refunds from credit balance report and completing insurance requests to include follow up. Interact with insurance carriers in all aspects of claim resolution. Monitor and follow up Medicare and Medicaid accounts identified by recovery audit contractors (RAC). May be required to work overtime if needed.
QualificationsEducation/Certification: N/A
Experience:
Three years hospital billing in several financial classes preferred.
Two years recent hospital cash posting.
General accounting practices required
Skills Required
- Knowledgeable of all payers and experience interacting with insurance carriers
- Proficient in multiple payer software systems and clearinghouse tools
- Knowledge of billing codes and edits: CPT, ICD10, HCPCS, Modifiers, CCI Edits, MUE Edits, and claim formats
- Posting payments and denials via electronic posting and manual batch posting
- General accounting practices
- Two years recent hospital cash posting
- Three years hospital billing in several financial classes
What We Do
Onslow Memorial Hospital is a 162-bed acute care community hospital founded in 1944 and located in coastal North Carolina, serving Jacksonville and greater Onslow County. The facility provides a vast array of healthcare services, including state-of-the-art diagnostics. It is dedicated to its mission of providing excellent patient health services in a healing and family-centered environment, ensuring quality care for its local community.
