Job Title: Claims Verification Analyst
Division: Administration
Department: Management
FLSA Status: Non-Exempt
Summary: Responsible for following up directly with commercial, governmental and community payers to resolve claim issues and secure appropriate and timely reimbursement.
Duties and Responsibilities include the following. Other duties may be assigned.
1. Follow up with pending claims and work denials for all payers.
2. Initiates insurance follow up on aged, unresolved claims to ensure maximum reimbursement
3. Submit appeals and reconsiderations on claim rejections, underpayments and denials
4. Engage the coding follow-up team for any medical necessity or coding related appeals; Contact insurance companies/payers or patients to gather information necessary to complete appeal processing.
5. Set follow-up activities based on the status of the claim
6. Communicates identified payer trends such as denials for specific procedure or diagnosis codes, or other identified issues
7. Learn new systems and process solutions as they present themselves to ensure proper assignment and workflow.
8. Remain compliant with our policies, process, and legal guidelines.
Qualifications:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Language Ability:
Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Interaction requires courtesy and tact when dealing with patients, employees and third parties.
Math Ability:
Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
Computer Skills:
To perform this job successfully, an individual should have knowledge of Microsoft Word, Excel, Valant, Clover; Must be able to type 40-45 wpm is required.
Education/Experience:
High school diploma or general education degree (GED); and two to four years related experience and/or training; or equivalent combination of education and experience.
Knowledge, Skills, and Other Abilities:
· Strong verbal and written communication skills.
· Problem-solving skills.
· Analytical skills.
· Research skills.
· High degree of attention to detail.
· Proficient computer skills, including Microsoft Office.
Job Types: Full-time, Internship
Pay: $15.00 - $18.00 per hour
Benefits:
- 401(k)
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Schedule:
- 8 hour shift
Work Location: In person
