Claims Analyst Specialist

ONSLOW MEMORIAL HOSPITAL•Jacksonville, NC

17d•Onsite

About The Position

The Claims Analyst Specialist is knowledgeable about all payers and is responsible for tracking, reviewing, and following up on outstanding patient accounts to facilitate complete and prompt third-party payments and maximize cash flow. The role includes reviewing Patient Accounting Desktop, clearinghouse billing lists, and intermediary online error lists; contacting insurers and patients; filing primary, secondary, and tertiary insurance claims; rebilling; and reviewing payment remittances. The specialist reviews line-item denials and claim rejections for potential appeals or research and resubmission, and uses multiple payer software systems. Knowledge of billing codes and claim formats is required. Additional duties include posting payments and denials to patient accounts through electronic posting and manual batch posting, processing requested adjustments, reconciling bank deposits and payment posting daily, entering daily posting numbers in an accounting shared spreadsheet, processing refunds from credit balance reports, and completing and following up on insurance requests. The specialist interacts with insurance carriers to resolve claims and monitors and follows up on Medicare and Medicaid accounts identified by recovery audit contractors (RAC). Overtime may be required if needed.

Requirements

Two years of recent hospital cash posting experience.
Knowledge of general accounting practices.
Knowledge of billing codes, including CPT, ICD-10, HCPCS, modifiers, CCI edits, and MUE edits, and of claim formats.

Nice To Haves

Three years of hospital billing experience in several financial classes.

Responsibilities

Track, review, and follow up on outstanding patient accounts.
Review Patient Accounting Desktop, clearinghouse billing lists, and intermediary online error lists in a timely manner.
Contact insurance companies and patients; file primary, secondary, and tertiary insurance claims; rebill; and review payment remittances.
Review line-item denials and claim rejections for possible appeals or research and resubmission.
Use multiple payer software systems.
Post payments and denials to patient accounts through electronic posting and manual batch posting.
Process requested adjustments and complete daily reconciliation of bank deposits and payment posting.
Enter daily posting numbers in an accounting shared spreadsheet.
Process refunds from credit balance reports and complete and follow up on insurance requests.
Interact with insurance carriers in all aspects of claim resolution.
Monitor and follow up on Medicare and Medicaid accounts identified by recovery audit contractors (RAC).