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Job FamilyInsurance Services
DepartmentCS Provider Patient Financial Services
Scheduled Weekly Hours40
ShiftDay (United States of America)
Job SummaryPerform duties necessary to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines.
- Demonstrates application of compliance standards and payer specific data to properly file claims and ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback.
- Demonstrates a working knowledge of third party payer procedures including, but not limited to: Commercial Payers, Veterans Administration, worker' compensation, third-party liability, county payers, and all other third party contractual agreements as required.
- Conducts timely follow up of claims. Use tools provided to track and trend patterns of claim submission issues that might require Compliance and Charge master staff to resolve, or HIPAA transaction code set review. Research payer requirements and offer suggestions to leadership for claims submission issues.
- Maintains and updates appropriate system documentation to provide information regarding claim processing to internal or external customers.
- Identifies unresolved requests of patient responsibility and transfers account to self pay. Performs duties and provides best customer service using behaviors that demonstrate responsibility and accountability.
- Participates in departmental activities related to performance improvement and quality control.
- Demonstrates a working knowledge of denial follow up and first level appeals.
- All other duties as assigned.
Education - High School Diploma/GED Equivalent in General Studies
Experience - 1+ years of Clerical Experience; 1+ years of Medical Patient Accounts/Financial Services Experience
Education - Bachelors degree in Accounting, Business, Health Related Field
Certifications - Certified Clinical Account Technician (CCAT) - Accredited University or accredited training professionals; Certified Patient Account Technician (CPAT) - Accredited University or accredited training professionals
Hours of operation are 6:00am - 6pm. Monday - Friday (no weekends)
Required to work 8 hour shifts between these hours
Required to work in office / no work from homeSedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.15 Corporate Services Division
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Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.Apply