Claims Administrator / Project Manager

HHC•Indianapolis, IN

4d•Onsite

About The Position

This position is responsible for managing payor enrollment, electronic claims submission, electronic remittance advice, electronic payments new sites, site conversions for all divisions, and creates dashboards for operational leaders. Ensures claims are processed timely, in accordance with federal and state laws, regulations, and payor guidelines. Manages an average of 475K hospital claims ($28.8B charges) and an average of 750K professional claims ($144.2M charges) per year for all divisions. Works closely with department leadership as well as vendors to solve and prevent claims issues through development and implementation of system logic, reducing manual processes, and increasing efficient workflows supporting timely reimbursement for all services rendered for all divisions. Manages and builds payor reimbursement contracts in EHR Contract Manager to monitor expected and actual reimbursement from all contracted payers.

Requirements

Bachelor’s degree in a business-related field, Health Information Administration, or related area required
More than four years of experience directly related to hospital billing, coding, claims administration, or related roles may be accepted in lieu of degree
EPIC HB and/or PB Contract Manager Certification required or must be obtained within 1 year
Five plus years of billing experience required
Epic and nThrive experience required
Minimum of 5 years of related experience in a hospital/medical environment may be accepted in lieu of educational requirements
Coding credential from AHIMA or AAPC required within 1 year
Excellent critical thinking, analytical, and problem-solving skills to research issues involving accounts, claim holds, and other issues impacting revenue.
Excellent organization skills, must be able to manage multiple priorities and exercise initiative to ensure timely completion of responsibilities
Detailed and multi-task oriented due to the large volume of data being collected and reported
Excellent verbal and written communication, and organizational skills are required; ability to communicate issues to management, and other teams within Revenue Cycle and other operational areas including Patient Access, EPIC Teams, IT staff, vendors, and payers
Extensive knowledge of uniform billing requirements, claim forms, and 837 transaction files
Excellent analytical skills
Ability to analyze reports, troubleshoot issues with claims, interfaces, and payer transactions impacting accounts receivable
Ability to import data, and to develop and build complex reports in Excel, nThrive and other systems
Extensive experience with Microsoft Word, Excel, and PowerPoint to design and manage reports
Ability to learn software quickly; ability to manipulate and interpret data

Responsibilities

Manages claim imports and exports for EHR and vendor systems, adds payers, NPIs, locations and ensures timely completion of EDI, ERA, and EFT enrollments, and manages electronic claim forms, and system logic
Reports trends in rejection, clean claim rates and recommends changes to resolve issues, develops, tests, implements and maintains claim edits and bridge routines
Creates and reports claims related dashboards to SLT
Maintains contract manager within EHR for both HB and PB billing and manages reimbursement variances
Conducts oral and written training of payor requirements and use/navigation of vendor systems
Manages EHR work queues for external errors, denials, new locations.
Ensures timely receipt of ERAs, works with vendor to obtain missing files.
Serves as security administrator for all payer websites, which includes managing user access to all payer portals, Clearinghouse, internal SharePoint site, and other required access needs for all divisions and external vendors
Manages external vendor access and claim activity
Manages multiple projects supporting efficient and timely claims processing
Facilitates meetings with internal leaders and vendors