Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 45 clinic locations, the area’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary

The role of the reports to the Insurance Claims Analyst Senior reports to the Billing Manager. This position is responsible for ensuring the accurate billing of medical claims to insurance payors.

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
• Assist with training of new staff members including analyzing workflow and progress
• Partner with leadership to establish performance optimization strategies
• Assist with special project, as needed
• Participate in planning and management of department resources
• Ensure all services are performed as mandated by WRMS Compliance and Code of Conduct guidelines
• Other duties as assigned

Qualifications

• Education: High school diploma or GED
• Licensure and Certifications: N/A
• Experience: Minimum 2 years of prior medical billing experience, required. Previous experience with CPT, HCPCS, and ICD-10 coding guidelines, preferred.

Work Environment: This position will spend 90% of work time sitting while performing work in a standard office environment and 10% of time standing and/or walking while occasionally pushing, pulling, lifting and/or carrying up to 50 lbs.