Claims Analyst | Home Plus Pharmacy | Full Time 40 Hours

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Job Category

Revenue Cycle

Job Family

Patient Financial Services

Department

Home Plus RC Pharmacy-Specialty

Scheduled Weekly Hours

40

Shift

Employee Type

Regular

Job Summary

Performs those 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.

Job Description

Essential Functions:
●Conducts timely follow up of claims as needed.
●Demonstrates application of compliance standards and payer specific data to properly file claims, 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 payor procedures including, but not limited to; Medicare, Medicaid, Champus, Blue Cross and all other third party contractual agreements entered into.
●Uses 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 payor 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.
●All other duties as assigned.

Additional Requirements

Preferred:
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

Physical Requirements:
Sedentary 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.

40 Monument Health Home Plus

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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.

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