Position Summary

The role of the Insurance Claims Analyst reports to the corresponding Insurance Billing Manager. This position is responsible for providing exceptional billing and AR follow up of Washington Regional Hospital and Clinic claims. This position oversees research and resolution of insurance billing issues at the time of claims submission, receipt of denial or non-contracted payment, and refund requests. This position must have the ability to learn and understand multiple software systems.

Essential Position Responsibilities

• Review and research insurance denials receive through insurance remittances, payor correspondence, or Clearinghouse rejections in an accurate and timely manner

• Respond appropriately to payor denials through written and/or verbal appeals processes for payor specific denials
• Provide effective communication with patients, insurance companies, and staff
• Maintain AR collection of claims at less than 30 days of account age
• Collaborate with necessary departments to ensure overall account accuracy and issue resolutions
• Reconcile transactions to ensure payments are balanced
• Provide timely and efficient follow-up on all outstanding AR using assigned ATB worklist reports, using various systems including: Payor portals, Payor phone inquiries and/or written communications
• Assigned to specific insurance(s) and providers/specialties but expected to learn on the job other insurances and specialties for career growth
• Maintain current assigned insurance(s) guidelines, policies, and procedures related to payment of claims

Qualifications

• Education: High School graduate or GED
• Licensure and Certifications: N/A
• Experience:
  • Previous billing and claims experience within a hospital and/or clinic business office with 2+ year experience, preferred.
  • Basic working knowledge of the MS Office suite of software, and the ability to operate standard office equipment.
  • Broad knowledge of medical terminology, medical collections, MS-DRG coding methodology, ICD-10 and CPT coding, preferred.

Work Environment: This position will spend 80% of time sitting while performing work in a standard office environment and 20% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs.