Insurance Claims Processor I

United Regional•Wichita Falls, TX

About The Position

The Insurance Claims Processor I prepares and files insurance claims for hospital and physician services using UB-04 and CMS 1500 forms. The role calculates insurance benefits, allowances, adjustments, and patient balances; processes and tracks payer reimbursement; and maintains positive working relationships with patients, insurance companies, and hospital departments. Work from home may be available after 60–90 days of on-the-job training, provided the employee has internet access and a secure home office.

Requirements

High school graduate or equivalent.
Ability to communicate effectively in English, verbally and in writing.
Knowledge of insurance and the ability to analyze and compile billing data for UB-04 and CMS 1500 forms.
Knowledge of third-party payer filing practices.
Ability to calculate insurance benefits, allowances, adjustments, and patient balances.
Knowledge of the appeal process for government payers and other assigned payers.
Ability to analyze payment practices of government payers and other assigned payers.
Diligence, patience, and persistence in obtaining information needed for outstanding accounts.
Ability to read, comprehend, 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 mathematical knowledge, including debits and credits for accurate account transactions.
Typing speed of 45 words per minute, with accurate spelling and grammar in account documentation and written communications.
For work from home, 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 obtained through related work experience or vocational school.
Familiarity with insurance and medical terminology.

Responsibilities

Compile patient, hospital, and insurance data to prepare accurate insurance claims, and review LMRP queries to support proper processing.
Review patient accounts and post or correct appropriate adjustments.
Investigate and correct questionable patient-account charges.
Process and track hospital and physician claims, meeting filing deadlines and using the billing process to file claims accurately each day.
Apply 24/72-hour regulations as required.
Verify and calculate hospital and physician payments; follow up promptly on incorrect payments and 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 payer inquiries to determine claim status, ensuring payers receive the information needed to identify and process claims.
Provide payers with requested claim information and document information pending from other providers.
Follow up with other providers for outstanding claim information and contact patients when information is needed.
Persistently follow up with payers while maintaining tact and diplomacy.
Notify management of recurring discrepancies or potential reimbursement problems.
Process daily reports, mail, email, 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 appropriate assistance with combining accounts.
Work the non-billable report daily and ensure adjustments are posted accurately and promptly.
Document pertinent account information, including names and phone numbers when applicable.
Maintain accurate insurance information and make changes when needed.
Review and work queues according to expectations.
Maintain good working relationships with coworkers and revenue cycle departments and meet departmental productivity standards.
Perform other tasks and responsibilities as necessary.