Physician Insurance Analyst 3
Job DescriptionAs a Physician Insurance Analyst 3, you will perform the duties of a Physician Insurance Analyst 1 and 2 while taking ownership for the timely and accurate editing, submission and/or follow-up of assigned claims in order to meet expected productivity and quality standards on a weekly basis. To help achieve our mission, you will process claims for all payer types (e.g. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Your ability to ensure that all assigned claims meet clearinghouse and/or payer processing criteria is of vital importance. Processing payer response/rejection reports timely while meeting departmental productivity and quality review standards is required. Identifying and reporting trends while assisting in the development and deployment of training relative to trends is expected.
- Ensures that all clean claims are submitted the day they are received, via the appropriate medium and with all required attachments.
- Provides resolution for pended claims within allowable timeframes, as defined for appropriate deficiency, and/or provides appropriate account follow-up based on established System Response Guidelines and Matrix.
- Resolves basic issues either through individual actions or by seeking assistance and direction from management.
- Meets productivity and quality expectations weekly for assigned work lists and any supervisor assigned special tasks.
- Correctly completes write-off requests and submits them daily for supervisor review.
- Documents and reports claims submission issues immediately and provides feedback to management.
- Ensures that payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards.
- Identifies issues with payer rejections and provides feedback regarding rejections to management.
- Maintains knowledge of payer requirements, 1500 standards and system (e.g. vendor, clearinghouse, payer) functionality and policies/procedures.
- Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence. Completes all assigned Epic billing/claim edits and ensures all required reports are filed timely and accurately.
- Ensures documentation is professional, appropriate, accurately depicts actions performed and is in accordance with departmental quality review standards.
- Ensures that all daily, weekly and monthly reports are completed, submitted timely and with minimal errors.
- Works all assigned Epic billing and claim edits daily.
- Identifies opportunities for Revenue Cycle performance improvement based on regulatory, payer, physician, departmental and/or multiple specialty service line analysis (e.g. Neurology, Cardiology, Oncology, Behavioral Health, Neurosurgery, Orthopedic and General Surgery).
High School or GED - Two years of college or an additional two years of experience appropriate to the position under consideration.
Two years of experience in Revenue Cycle operations, billing, collections, cash posting and/or administrative support in physician billing.
- Working knowledge of Patient Accounting Systems.
- Working knowledge of Microsoft Office products or equivalent software. Microsoft Office
- Keyboard and CRT skills. Technology/ Computer