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Corvallis

    Revenue Cycle AR Claims Specialist - Corvallis, United States - Corvallis Clinic Business Office

    Corvallis Clinic Business Office
    Corvallis Clinic Business Office Corvallis, United States

    3 weeks ago

    Default job background
    Description
    Compensation: $ $22.05 per hour (based on yearsof experience)

    Summary:

    The responsibility of the RevenueCycle Claims Specialist is to maintains current knowledge of insurancecarriers' rules, regulations, and contracts; acts as a liaison for patientswith the insurance carrier for internal/external customers; and is responsible forposting payments, adjustments, status, and reason codes. Contracts are reviewedfor accuracy of payment with direct communication with payer provider reps. Analyzeand test new system modules and upgrades. Confirmed and maintains mandatedrequirements for provider rosters.

    Responsibilities:

    1. Will participate and maintain a culture withinThe Corvallis Clinic that is consistent with the content outlined in theService and Behavioral Standards document. To this end, employees will beexpected to read, have familiarity with, and embrace the principles containedwithin.

    2. Researches and resolves claims based onassignment, which could include contacting payers via phone or website,contacting practices, working across departments, writing appeals, andfacilitating their submission, and all other activities that lead to thesuccessful adjudication of eligible claims including but not limited to:
    • Providesmedical record documentation to insurance companies as requested
    • Filesclaims using all appropriate forms and attachments
    • Communicateswith insurances companies about insurance claims, denials, appeals andpayments
    • Researchdenied and improperly processed claims by contacting insurance companies orutilizing online payor portals to ensure proper processing and/or reprocessingof claims. Works directly with provider reps to escalate claims issues
    • Resubmitsdenied and improperly processed claims to insurance payers in a timely manner
    • Creates,reviews, and works insurance aging reports to identify unpaid insurance claims,corrects any errors, and resubmits claims as needed to ensure timely andaccurate payments are received
    • Tasks appropriatestaff while working vouchers for denials, $0 pay, and refunds
    • Communicateswith practices and payers regarding claim denials and payer trends
    3. Collaborates with PracticeManagement and the co-source model within the Electronic Health Record toensure files are kept up to date; identifies and requests support where needed:
    • Analyzesand tests new system modules and upgrades, providing recommendations tomanagement staff regarding necessary modifications, education, and training
    • Worksclosely with physician credentialing to meet insurance and governmentalmandates for updating insurance rosters quarterly
    • Responsiblefor maintaining and updating provider credentials, as well as updatinginsurance category classifications
    4. Identifiesroot-causes of claim issues and proposes resolutions to ensure timely andappropriate payment.

    5. Educatesand communicates revenue cycle/financial information to patients, payers,co-workers, managers, and others as necessary to ensure accurate processes.

    6. Identifiesissues and or trends with payers, systems, or escalated account issues and providessuggestions for resolution to management.

    7. Evaluatescarrier and departmental information to determine data needed to be included insystem tables.

    8. Completes tasks assigned throughworklists, reports, projects, team goals and objectives. Meetsproductivity standards as set by management.

    Education/Licensure/Experience:

    1. HighSchool diploma or equivalent required.

    2. Two (2) ormore years of successful experience within medical billing office, required.

    3. One (1) ormore years of customer service experience, required.

    4. Proficiency in Microsoft OfficeSuite; mainly Word and Excel, required.

    Knowledge and Skills:

    1. Intermediate computer skills, including MSWord and Excel

    2. Knowledge of medical terminology, CPT, ICD-9and ICD-10 coding

    3. Knowledge of finance/accounting, includinginsurance carrier billing

    4. Excellent oral and written communication skills

    5. Ability to work with difficult/upset people.

    6. Ability to collaborate well with providers andother staff.

    7. Ability to work on multiple taskssimultaneously in a busy, demanding environment while maintaining quality of work.
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