Insurance Analyst I

Eisenhower Health•Rancho Mirage, CA

52d

About The Position

Education: Required: High school diploma, GED or higher level degree Licensure/Certification: Required: N/A Experience: Required: One (1) year of billing/collections experience, billing certification or prior successful internship/temporary assignment in a patient financial service setting Preferred: Experience with managed care and Medicare/Medi-Cal Billing regulations Reports To: Director Supervises: N/A Ages of Patients: N/A Blood Borne Pathogens: Minimal/ No Potential Skills, Knowledge, Abilities: Ability to handle multiple projects/tasks at the same time and prioritize workload, Ability to interpret payer contracts and federal and state regulatory guidelines, Ability to operate basic office equipment ie copiers, fax machines and calculators, Ability to prioritize tasks and manage time efficiently to meet deadlines, Knowledge of computer based claims management, Knowledge of database systems and internet applications, Knowledge of Medical Terminology, Strong customer service and problem solving skills, Strong windows knowledge and keyboarding skills

Requirements

High school diploma, GED or higher level degree
One (1) year of billing/collections experience, billing certification or prior successful internship/temporary assignment in a patient financial service setting
Ability to handle multiple projects/tasks at the same time and prioritize workload
Ability to interpret payer contracts and federal and state regulatory guidelines
Ability to operate basic office equipment ie copiers, fax machines and calculators
Ability to prioritize tasks and manage time efficiently to meet deadlines
Knowledge of computer based claims management
Knowledge of database systems and internet applications
Knowledge of Medical Terminology
Strong customer service and problem solving skills
Strong windows knowledge and keyboarding skills

Nice To Haves

Experience with managed care and Medicare/Medi-Cal Billing regulations

Responsibilities

Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
Manages new accounts, on a daily basis, by working within Receivables Workstation; interfaces with other departments within the hospital, when appropriate, to obtain information necessary to process or resolve claims; contacts patient and/or account guarantor to solicit payment on account.
Works all accounts listed in the Follow-Up queue on a daily basis to promote collection of accounts; includes telephoning the payer, messaging or identifying the claim on the payers’ Internet websites.
Manages account inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.
Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.
Processes incoming correspondence, including signature letters, denials, prior authorizations and additional information necessary to process the claim.
Records newly identified insurance plans and facilitates the account processing of new plan in accordance with pre-billing policies and procedures.
Records accurate and definitive notes in the electronic account file that depict the current status of account, issues with account and anticipated date of resolution.
Escalates account management to leadership when issues arise, if needed.
Ensures leadership is kept up to date with contract, payer or system changes and/or issues.
Assigns a status code to each worked account to enable account tracking, statistical data gathering and audit activities.
Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance.
Handles special projects as directed by leadership e.g. high dollar accounts, accounts over 180 days old, etc.
Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.
Maintains productivity standards by payer assignment.
Performs other duties as assigned.