Claims Processor – UB-04, HCFA 1500

Job Description: • Prepares and submits hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing • Secures needed medical documentation required or requested by third party insurances • Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains • Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers • Responsible for consistently meeting production and quality assurance standards • Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer • Updates job knowledge by participating in company offered education opportunities • Protects customer information by keeping all information confidential • Processes miscellaneous paperwork • Ability to work with high profile customers with difficult processes • May regularly be asked to help with team projects • Ensure all claims are submitted daily with a goal of zero errors • Timely follow up on insurance claim status • Reading and interpreting an EOB (Explanation of Benefits) • Respond to inquiries by insurance companies • Denial Management • Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles • Review late charge reports and file corrected claims or write off charges as per client policy • Review reports identifying readmissions or overlapping service dates and ignore, merge, or split-bill according to the payer’s rules and the client’s policy • Review credit reports, resolve credits belonging to a payer when able, and submit a listing of credits to the facility as required by the payer Requirements: • 3 years of recent Critical Access or Acute Care facility and professional claim billing • Meditech E.H.R Experience Required • Computer skills • Experience in CPT and ICD-10 coding • Familiarity with medical terminology • Ability to communicate with various insurance payers • Experience in filing claim appeals with insurance companies Benefits: • Competitive salary • Flexible working hours • Professional development opportunities