Job Overview

 This role ensures accurate and timely initial payor claim submission and payment by reviewing and correcting claim edits, rejections and rebills. They are expected to have hands-on account resolution, maintaining the highest standards of quality, productivity, and compliance on an individual and team basis. Ability to work claims for multiple clients and systems. 

Job Duties and Responsibilities

· Submit hospital medical claims in accordance with federal, state and payer mandated guidelines. 

· Research, analyze, and review hospital claim errors and rejections and make applicable corrections. 

· Ensure proper hospital claim submission and payment through review and correction of claim edits, errors, and denials. 

· Maintain required knowledge of payer updates and process modifications to ensure accurate claims. 

· Investigate, follow up with payers, and work claims as assigned. 

· Determine reason for non-covered charges and take appropriate action. 

· Perform posting billing adjustments. 

· Ensure billing reroutes are worked timely and comply with company procedures. 

· Escalate stalled hospital claims to manager. 

· Identify and communicate payer specific issues to the team and leadership. 

· Participate and contribute to daily shift briefings. 

· Comply with productivity standards while maintaining quality levels. 

· Receptive to feedback and continual performance improvement, and willingness to grow and learn. 

· Punctual, dependable, and adapt easily to change. 

· Strong character by demonstrating accountability and responsibility.

· Perform work duties using ethical decision-making processes. 

· Other job duties as assigned.

Requirements and Qualifications

 · High school diploma or equivalent required; Associate degree preferred 

· 4+ years of work experience working with health insurance companies in securing payment for medical claims. 

· 3+ years of work experience with billing hospital claims and filing appeals with health insurance companies. 

· Experience using clearing houses systems such as Waystar, Quadex, SSi or similar platforms for billing. 

· Proficiency in Microsoft Office Suite, Teams, and various desktop applications. 

Knowledge, Skills & Abilities

 · Knowledge of coding guidelines for claim errors. 

· Understanding of Healthcare Revenue Cycle administration rules and regulations. 

· Knowledge of ICD-10 diagnosis and procedure codes as well as CPT/HCPCS codes. 

· Strong investigative skills to identify and resolve reasons for non-payment on medical accounts. 

· Proficiency in computers and Microsoft Office Suite/Teams, with experience using GoToMeeting/Zoom. 

· Ability to make informed decisions and take appropriate action. 

· Demonstrates a positive attitude and pleasant demeanor at work. 

· Willingness to learn, grow, and respond constructively to feedback for continuous improvement. 

· Professional interaction with colleagues and punctual, dependable work habits. 

· Ability to adapt easily to change and perform duties with ethical decision-making. 

· Demonstrates accountability, responsibility, and accomplishments in the revenue cycle process.