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Role Description

This role involves accurately submitting all insurance claims for all payer types, including Government payers, within claims clearinghouse application and patient accounting system.

• Resolve edits/rejections, ensuring accurate and timely claim submission in alignment with payer's regulations and filing limits.
• Adhere to compliance and regulatory rules as mandated by CMS, state and federal regulations, payer contracts, and established Presbyterian Healthcare Services (PHS) department policies and procedures.
• Perform a variety of duties that include the use of payer web portals or calls to insurance companies to resolve billing errors.
• Review and resolve individual work queues within patient accounting system for clean import into clearinghouse.
• Responsible for submission of all electronic claims within clearinghouse.
• Submit paper claims to non-electronic payers with required documentation if necessary.

Qualifications

• High School Diploma or GED required.
• Less than 1-year clerical or customer service experience preferred.
• Must be passionate about contributing to an organization focused on continuously improving patient experiences and the health of our community.
• Experience with Microsoft Office Suite products required.
• Excellent organizational, problem-solving, verbal and written communication skills.
• Attention to detail and the ability to interact effectively with other functional areas and management teams are required.
• Must have a strong work ethic and demonstrated ability to work effectively in a team environment.
• Must be able to prioritize and manage a high-volume workload.
• Must be able to work in a fast-paced environment and contend with continually changing payer regulations and requirements.
• Basic knowledge of ICD-10, HCPCS, CPT codes, Revenue Codes, UB04 and HCFA 1500 claim forms and an understanding of electronic processing of 837 and 835 is preferred.
• Basic knowledge of Coordination of benefits and the Medicare MSPQ preferred.
• Must have basic knowledge of various payer requirements, claim submission processes for major insurances carriers and intermediaries.
• Must have basic knowledge of the revenue cycle processes.
• Must have the ability to provide a high-speed DSL or cable modem for a home office with a minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload).
• Must be able to provide a confidential work space that is HIPAA compliant and free from distractions.

Benefits

• Comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance, and other optional voluntary benefits.
• Employee Wellness rewards program designed to provide engaging opportunities to enhance health and activate well-being.