Job Description

Job Location Eastover - Charlotte, NC 28204

General Summary: A nonexempt position responsible for the proper and timely processing of claims and payments to providers.

Essential Job Responsibilities:

1. Weekly review of claim edits reports and corrects the claim information such as (CPTs, valid ICD-10's, referring doctor name/UPIN #, modifiers, etc.).
2. Work and corrects claim rejections from Waystar, correcting necessary data.
3. Daily follow-up of aged accounts and denied charges.
4. Keep A/R Supervisor informed on all Payer problems.
5. Contacting insurance carriers via phone or website.
6. Handle patient and provider calls in reference to claims or statements.
7. Answer and forward incoming calls in a timely manner.
8. Identifies and resolves patient billing complaints.
9. Performs various collection actions including contacting patients by phone, correcting, and resubmitting claims to third party payers.
10. Identify and correct posting errors and overpayments.
11. Review and correct COB errors.
12. Other duties and projects as assigned.
13. Occasional overtime may be required.

Qualifications

Education: High school diploma or equivalent.

Experience: Minimum two years of experience working insurance AR follow up and claims processing in a health care setting; including denials and appeals.

Other Requirements: None

Performance Requirements:

Knowledge:

1. Knowledge of clinic policies and procedures.
2. Knowledge of health care insurance claim practices and compliance.
3. Knowledge of computer systems, programs, and applications.
4. Knowledge of medical terminology.

Skills:

1. Skill in gathering and reporting claim information.
2. Skill in trouble-shooting claim insurance problems.
3. Skill in written and verbal communication and customer relations.

Abilities:

1. Ability to work effectively with physicians, other medical staff, and external agencies.
2. Ability to identify and analyze claim problems.