Insurance Claims Processor I

United Regional•Wichita Falls, TX

2d•Hybrid

About The Position

The Insurance Claims Processor I prepares and files hospital and physician insurance claims, computes benefits and patient balances, and follows up with payers to verify and obtain reimbursement. The role reviews patient-account activity, corrects charges and adjustments, investigates denials or incorrect payments, and ensures claims are filed accurately and on time. It requires professional communication with payers, patients, providers, and hospital departments, along with thorough documentation and maintenance of accurate insurance information. Work-from-home availability begins after 60–90 days of on-the-job training. Remote work requires internet access and a secure office space.

Requirements

High school graduate or equivalent.
Effective verbal and written communication in English.
Knowledge of insurance and the ability to analyze and compile billing data on UB-04 and CMS 1500 forms.
Knowledge of filing practices for third-party payers.
Ability to calculate insurance benefits, allowances, adjustments, and patient balances.
Knowledge of the appeals process for government payers and other assigned payers.
Ability to analyze payment practices of government and other assigned payers.
Ability to obtain required information on outstanding accounts with diligence, patience, and persistence.
Ability to read, understand, and apply governmental rules and regulations.
Ability to use available tools, including payer websites.
Knowledge of patient accounts and ability to discuss account information with patients and insurance companies.
Basic mathematics skills, including understanding debits and credits for accurate account transactions.
Typing speed of 45 words per minute, with correct spelling and grammar in account documentation and written communications.
For work from home, must have internet access and a secure office space.
Ability to use office equipment, including computer terminals, telephones and telephone headsets, copiers, a 10-key adding machine, and a fax machine.

Nice To Haves

One to two years of billing and/or claims follow-up experience gained through related work experience or vocational school.
Knowledge of insurance and medical terminology.

Responsibilities

Compile patient, hospital, and insurance data to prepare insurance claims, and review LMRP queries to support proper processing.
Review patient accounts, post or correct appropriate adjustments, and investigate questionable charges.
Process and trace hospital and physician claims while meeting timely-filing deadlines.
File claims accurately each day and apply 24/72-hour regulations to ensure compliance.
Verify and calculate payments, follow up promptly on incorrect payments or denials, and maintain accurate account status.
Generate secondary billing when applicable and determine whether to re-file a claim, issue a refund, or process an adjustment.
Submit professional written and verbal inquiries to payers to determine claim status and provide identifying information.
Provide payers with requested claim information, document information pending from other providers, follow up with those providers, and contact patients for required information.
Maintain diligence, tact, and diplomacy when following up with payers.
Notify management of recurring discrepancies or potential reimbursement problems.
Process daily reports, mail, emails, and phone calls; work received mail within two days and document information in patient account notes.
Identify Medicare and Medicaid combined messages daily and obtain assistance combining accounts.
Work the non-billable report daily and ensure adjustments are posted accurately and promptly.
Document pertinent information in patient account notes, including names and phone numbers when applicable; maintain and update insurance information.
Review and work queues according to expectations.
Maintain good working relationships with coworkers and revenue cycle departments.
Meet productivity standards set by the department.
Perform other tasks and responsibilities as necessary.