Commercial Claims Analyst-Non Governmental

Description

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

• Expedites the settlement of insurance claims by submitting accurate claims and performing appropriate follow-up activities in a timely manner.

Responsibilities:

1. Files insurance claims in an accurate, timely manner within 1 business day from billed date.

a. Utilize electronic billing system for submission of claims for certain payers.

• • Paper claims with appropiate documentation are filed timely.
  • Utilize appropriate resources to review accounts as needed for insurance verification.
• • Proficiency and accuracy is required for all work performed on daily basis. Knowledge of different system is required.

2. Processes commercial payment vouchers timely.

• • Accounts are verified for correct reimbursement with contract terms.
  • Payments and adjustments are posted the date received.
  • Correct plan codes are utilized for posting.
  • Secondary payors are filed the date voucher has been received.
  • Denials are documented.
  • Insurance refunds are processed and docemented timely, and the appropriate action is taken.
  • Monthly refunds are balanced with General Ledger and the AR Summary, reports are due timely.
  • Accounts are reclassified to reflect payments/denials for collection activity.
  • Transactions and payments are posted correctly and timely to reduce AR days. Denials are reviewed and processed daily for timely reimbursement.
• Traces/follow-ups on claims are accurate and timely.
• • Accounts are properly documented.
  • Claims are traced according to prioritization of timely filing limits and high dollar balances.
  • Collection letters are utilized within the appropriate time.
  • Monthly reports by payor are analyzed and worked appropriately.
  • To ensure timely reimbursement and to reduce AR days. To prevent time from delay of processing claims.

4. Reviews commericial, managed care contact data frequently.

• • Records are maintained for accurate billing and reimbursement for managed care contracts.
  • Reviews and disseminates to management staff insurance publications.
  • Commercial correspondence is processed daily to prevent payment delays. Accounts are reclassified to reflect denials/payments for collection activity to begin.

Qualifications

EDUCATION REQUIREMENT

• High school diploma or equivalent required.

PROFESSIONAL EXPERIENCE REQUIREMENT

• Minimum 1 year experience working with insurance related field preferred. Computer background required. Knowledge of managed care contracting terms preferred.

LICENSURE/REGISTRATION/CERTIFICATION

• None.

KNOWLEDGE, SKILLS, AND ABILITIES REQUIREMENTS

• Excellent organizational skills required. Proficient written and oral communication skills.
• Ability to utilize personal computer, electronic calculator, and other office equipment.
• Basic accounting background and medical terminology preferred. Strong analytical ability preferred. Excellent customer service skills required.

Job Details

Legal Employer: Lenoir Health

Entity: UNC Lenoir Health Care

Organization Unit: Patient Accounting

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: LENOIR MEM

Exempt From Overtime: Exempt: No

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.