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Claims Processor - Physician Billing Office - Mercy Medical Center - Full Time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Des Moines, IA Des Moines, Iowa |
About this job
GENERAL SUMMARY:
Workrequires an understanding of detailed practice management requirements. Work also requires an understanding ofbilling requirements, claims attachments and claim rejections, remark andreason codes, as well as attention to detail, the ability to accurately andtimely troubleshoot/resolve questions/issues and to resolve issues which mayhave a potential impact on revenues.
ESSENTIAL FUNCTIONS:
ERAMaintenance Representative:
This job is responsible for reconciling and applying allERA payment files for Mercy Clinics Inc (MCI) in accordance with the currentpractice management system processes and cash reconciliation guidelines.
* Test incoming remits for all electronic payers
* Update all remits with a high level of accuracy
* Print and distribute check summaries for allelectronic payers
* Verify a match between all remits and checksummaries received
* Complete ERA Batch Header form for all remitsthat will be posted in Production
* Distribute all posted ERA reports
* Act as the primary liaison with the Payment Postingteam for questions related to electronic remits.
ClaimMaintenance Representative:
This job is responsible for submitting claims for MercyClinics Inc (MCI) in accordance with payer regulations and applicableguidelines. An incumbent will facilitatethe overall claim process through submission of both electronic and paper-basedclaims, resolution of claim-form edits and validation of data integrity.
* Reviews claims for all necessary requirements for billing,including complete patient and insurance information; completes paper claimprocessing in a timely and accurate manner.
* Resolves all claim edits, in both the billing system andthe clearinghouse, accurately and timely through attention to detail andcritical thinking skills in accordance with payer regulations and guidelines.
* Maintains claim notes documenting steps taken to resolveclaim edits.
* Accurately complete appropriate forms for notifying clinicsof claims that need additional information to resolve edits.
* Accurately complete appropriate forms for claimadjustments.
* Notifies Supervisor of claim submission requirement changesand electronic billing errors.
* Completes payer specific edits using knowledge of payerreimbursement methodologies or government regulations.
MARGINALFUNCTIONS:
* Work includes cross coverage in other areas of department as needed.
* Participates in performance improvement projects and activities as needed.
* Work includes all other miscellaneous office duties/projects asassigned.
* Work hours may vary throughout the month/year as required based onscope of the position.
MINIMUM KNOWLEDGE, SKILLSAND ABILITIES REQUIRED:
* High schooldiploma required
* Three years (recent)of physician office or related healthcare experience required
* Ability to assimilate and synthesize information
* Demonstrates written, verbal, and nonverbal communication that isconsistent with the Mercy Mission, Values and I Will Statements to allpatients, families, visitors, medical staff, colleagues, vendors and otherinternal and external customers.
* Excellent organizational and time management skills
* Must be a self- started and demonstrate the ability to workindependently by making appropriate decisions according to the organizationaland departmental guidelines that fall within the scope of the position.
* Demonstrates the ability to understand and effectively utilize a highlycomplex billing system(s).
* Maintains current knowledge of all Federal, State and complianceregulations related to billing and insurance as required based on the scope ofthe position.
* Demonstrates an understanding of HCFA 1500 claim forms, CPT, ICD.10 andHCPCS codes specific to insurance carrier requirements as required based onscope of the position.
Workrequires an understanding of detailed practice management requirements. Work also requires an understanding ofbilling requirements, claims attachments and claim rejections, remark andreason codes, as well as attention to detail, the ability to accurately andtimely troubleshoot/resolve questions/issues and to resolve issues which mayhave a potential impact on revenues.
ESSENTIAL FUNCTIONS:
ERAMaintenance Representative:
This job is responsible for reconciling and applying allERA payment files for Mercy Clinics Inc (MCI) in accordance with the currentpractice management system processes and cash reconciliation guidelines.
* Test incoming remits for all electronic payers
* Update all remits with a high level of accuracy
* Print and distribute check summaries for allelectronic payers
* Verify a match between all remits and checksummaries received
* Complete ERA Batch Header form for all remitsthat will be posted in Production
* Distribute all posted ERA reports
* Act as the primary liaison with the Payment Postingteam for questions related to electronic remits.
ClaimMaintenance Representative:
This job is responsible for submitting claims for MercyClinics Inc (MCI) in accordance with payer regulations and applicableguidelines. An incumbent will facilitatethe overall claim process through submission of both electronic and paper-basedclaims, resolution of claim-form edits and validation of data integrity.
* Reviews claims for all necessary requirements for billing,including complete patient and insurance information; completes paper claimprocessing in a timely and accurate manner.
* Resolves all claim edits, in both the billing system andthe clearinghouse, accurately and timely through attention to detail andcritical thinking skills in accordance with payer regulations and guidelines.
* Maintains claim notes documenting steps taken to resolveclaim edits.
* Accurately complete appropriate forms for notifying clinicsof claims that need additional information to resolve edits.
* Accurately complete appropriate forms for claimadjustments.
* Notifies Supervisor of claim submission requirement changesand electronic billing errors.
* Completes payer specific edits using knowledge of payerreimbursement methodologies or government regulations.
MARGINALFUNCTIONS:
* Work includes cross coverage in other areas of department as needed.
* Participates in performance improvement projects and activities as needed.
* Work includes all other miscellaneous office duties/projects asassigned.
* Work hours may vary throughout the month/year as required based onscope of the position.
MINIMUM KNOWLEDGE, SKILLSAND ABILITIES REQUIRED:
* High schooldiploma required
* Three years (recent)of physician office or related healthcare experience required
* Ability to assimilate and synthesize information
* Demonstrates written, verbal, and nonverbal communication that isconsistent with the Mercy Mission, Values and I Will Statements to allpatients, families, visitors, medical staff, colleagues, vendors and otherinternal and external customers.
* Excellent organizational and time management skills
* Must be a self- started and demonstrate the ability to workindependently by making appropriate decisions according to the organizationaland departmental guidelines that fall within the scope of the position.
* Demonstrates the ability to understand and effectively utilize a highlycomplex billing system(s).
* Maintains current knowledge of all Federal, State and complianceregulations related to billing and insurance as required based on the scope ofthe position.
* Demonstrates an understanding of HCFA 1500 claim forms, CPT, ICD.10 andHCPCS codes specific to insurance carrier requirements as required based onscope of the position.