Responsible for working outstanding insurance claims having no response from payors, having edits, and having received claim form related denials. Maintains A/R at acceptable aging levels by prompt follow-up of unpaid claims and denied claims. Provide information over the phone for billing related questions directed to the central business office. Review credit balances for possible refunds.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
Thoroughly and timely work follow up records in work queues as defined by policies and procedures.
Process insurance claims correspondence. Read and interpret EOB's (Explanation of Benefits)
Process appropriate refund in accordance with department policies and procedures.
Present unresolved concerns to Supervisor for resolution immediately with related documentation.
Document account activity accurately and promptly during or immediately following each processed encounter.
Responsible for the accurate and timely submission of claims, denials, and re-bills of insurance claims.
Responsible for the analysis and necessary corrections of patient accounts as it pertains to clean claim submissions or re-bills.
Responsible for maintaining work queues.
Responsible for telephone and/or written correspondence with insurance companies for claims follow up.
Responsible for correctly identifying and updating various types of insurance entry information.
Maintain basic understanding and knowledge of health insurance plans, policies and procedures.
EDUCATION AND SKILLS
High school diploma or equivalent.
Minimum of one year experience in health care accounting within a medical office strongly preferred, or equivalent combination of education and experience.
Knowledge of private billing and collections regulations experience preferred.
Must be a proactive problem solver, foster teamwork and trust, be highly skilled in prioritizing, organizing, planning, communication and staying on track.
Demonstrated customer service expertise.
Knowledge of government, commercial, and third party insurance contract practices and claims processing procedures preferred.
Keyboarding minimum 40 wpm.
Accurate 10 key by touch and familiarity with Microsoft Word and Excel.
Excellent organizational skills required.
Must be able to work in a highly demanding atmosphere, with a variety of personalities within a fast paced environment.
Excellent verbal and written communication skills, and extensive hands-on computer background.
Must have reliable and predictable attendance.
The above information is intended to indicate the general nature and level of work required in this position. It is not designed to contain or be interpreted as a comprehensive description of all duties, responsibilities, and qualifications required of those assigned to this job.
We offer a competitive Total Rewards Program which includes insurance programs covering medical, dental, vision, life, long-term disability, generous time off, holidays, education reimbursement, and a 401(k) plan. Eligibility for benefits is dependent on factors such as position type and FTE. Contact your recruiter for more information.
Vancouver Clinic is proud to be an Equal Opportunity Employer. Vancouver Clinic does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, gender identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.
