Junior Claims Analyst

Description

SUMMARY:

Billing and Accounts Receivable for Outpatient Third Party Claims.

SUPERVISORY RESPONSIBILITIES:

N/A

ESSENTIAL DUTIES AND RESPONSIBILITIES:

The Duties and Responsibilities reflect the general details considered necessary to describe the principal functions of the job and shall not be construed as a detailed description of all related work assignments that may be inherent to the job.

• Daily review of outpatient claims available to bill to third party insurance for assigned programs and/or insurers.
• Scrub all claims available to bill to ensure correct insurance, billable provider, and CPT/HCPCS codes are used for the procedure.
• Submission of claims, paper and/or electronic, for outpatient third party claims, within timely filing limits.
• Follow up of billed claims to ensure acceptance by insurer.
• Reprocessing of rejected or denied claims within timely corrections limits.
• Timely write off of unbillable claims or rejected/denied claims that cannot be corrected.
• Payment application for assigned third party insurance payments (direct deposit, 835 remittance, and checks).
• Maintenance of electronic filing system for third party insurance payments received.
• Timely review and resolution of A/R issues for assigned outpatient third party payers.
• Cross-train with other Business Office staff as assigned by supervisor; back-up coworkers’ duties as requested, i.e. illness or vacation.
• Perform other duties as assigned by supervisor.

Qualifications

CORE COMPETENCIES:

• Maturity and sensitivity to the special needs of PPBH clients and employees.
• Ability to show attention to detail.
• Must be service oriented with good speaking, listening and customer service skills.
• Must possess good Problem-solving, Teamwork, and Communication skills

QUALIFICATIONS, EDUCATION AND/OR EXPERIENCE:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.  The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• High School Diploma and two years related experience in billing and use of Electronic Health Records.
• Billing and Coding certification preferred but not required.
• Ability to read and interpret accounts receivable documents and Explanation of Benefits.
• Ability to communicate effectively and apply common sense understanding to carry out instructions both verbally and in writing with individuals served, in staff meetings, and with supervisors.
• Ability to work independently with minimal direct supervision
• Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
• Computer Skills: Ability to operate at intermediate level Microsoft Excel, Word, Microsoft Outlook, and Access.

REQUIREMENTS:

• A valid Class E Drivers’ License for positions that require driving personal or Agency vehicle on Agency business.
• Must maintain a minimum Bodily Injury & Property Liability insurance limit of at least $50,000 for positions that require driving personal own vehicle (POV) on Agency business. (Proof Required)
• PPBH is a 24/7 Agency.  All employees must be available as needed when required.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this position.  Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

While performing the duties of this job, the employee is regularly required to stand, walk, sit, talk, hear, and use hands to finger, handle, or feel objects, tools, or controls. The employee will occasionally lift and/or move up to 25 pounds.  Specific vision abilities required by this job include close vision, distance vision, depth perception, and the ability to adjust focus. 

WORK ENVIRONMENT:

The work environment characteristics are representative of those an employee encounters while performing the essential functions of this job.  The noise level in the work environment is usually moderate in a fast-paced work environment.

Salary : $50,000