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

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. Research and resolve claims based on assignment, which couldinclude contacting payers via phone or website, contacting practices, workingacross departments, writing appeals, and facilitating their submission, and allother activities that lead to the successful adjudication of eligible claims.

• Provides medical record documentation to insurance companies asrequested
• File claims using all appropriate forms and attachments
• Communicates with insurances companies about insurance claims,denials, appeals and payments
• Research denied and improperly processed claims by contactinginsurance companies to ensure proper processing and/or reprocessing of claims.Works directly with provider reps to escalate claims issues
• Resubmits denied and improperly processed claims to insurancepayers in a timely manner
• Creates, reviews, and works insurance aging reports to identifyunpaid insurance claims, correct any errors, and resubmit claims as needed toensure timely and accurate payments are received
• Task appropriate staff while workingvouchers for denials, $0 pay, and refunds
• Communicate with Practices and Payers regarding claim denialsand payer trends
• Research denied, delayed, and underpaid claims utilizing onlinepayor portals

3. Working with Practice Management and co-sourcemodel to keep files up to date and identify and seek support.

• Analyze and test new system modules andupgrades. Provide recommendations tomanagement staff regarding modifications, education, and training
• Collaborate with physician credentialing tosatisfied insurance and governmental mandate on insurance roster every quarter
• Maintaining and updating provider credentialsand updating insurance category classification

4. Monitor and execute work on assigned worklists, reports,projects, or team goals.

5. Meet productivity standards as setby management.

6. Demonstrate knowledge andunderstanding of insurance billing procedures as evidenced by the identificationof root-causes of claim issues and proposed resolutions to ensure timely andappropriate payment.

7. Educate and communicate revenuecycle/financial information to patients, payers, co-workers, managers, andothers as necessary to ensure accurate processes.

8. Reporting and Research: Identifyissues and/or trends and provide suggestions for resolution to management,including payer, system, or escalated account issues. Evaluate carrier anddepartmental information and determine data to be included in system tables.

Education/Licensure/Experience:

1. Two (2) or more years of successful experiencewithin medical billing office

2. Two (2) or more years of computer skills andPC experience, including word and Excel.

3. One (1) or more years of customer serviceexperience

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.