Position Overview:
Claims Analyst I must know the essential functions of submitting clean claims to commercial payers for accurate payments of services provided by Montrose Memorial Hospital. They must also be proficient in the Electronic Health Record system, Electronic Billing System, and all insurance portals. Can perform comprehensive follow-up with commercial payers for timely payment.

Essential Functions:
1. Maintains current knowledge of billing rules for third party commercial payers and workers compensation for hospital and physicians. 2. Run insurance aging reports to identify unpaid insurance claims that are 30 days old from date of service. Insurance must be contacted on a monthly basis via website or telephone for updates. 3. Reports discrepancies, admission errors, and coding questions to proper departments for ongoing process improvement. 4. Identify, bill, and follow-up on unpaid secondary or tertiary claims within assigned insurances and alpha split. 5. Follows policies and procedures for submitting appeals. 6. Updates job knowledge by actively participating in educational opportunites. 7. Maintains knowledge of facility electronic health record system and claims submission programs. Submitting claims electronically for faster payment. Billing of all primary, secondary and tertiary claims electronically as well as continious monitoring of payers able to be billed electronically. 8. Follows HIPAA (Health Insurance Portability and Accountability Act ) guidelines in handling patient information 9. Follows policies and procedures for entering communication to, from, or with patients into accounts. 10. Run daily reports such as late charge report, and accept/reject reports, etc. to ensure billing rules are followed and timely review of rejected claims. 11. Process credit balance accounts generating refunds to appropriate parties or correcting adjustments. 12. Create policies and procedures on a monthly basis. They must be detailed and easily followed by other staff in the department. Must refer to policies for guidance and if no policy exists will list on policy board to develop for future reference 13. Enhance billing department and organization reputation by accepting ownership for accomplishing new and different requests, exploring opportunities to add value to job accomplishments. 14. All other duties as assigned.
Physical Demands and Working Conditions:
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is occasionally required to stand, walk, sit, use hands to finger, handle and/or feel objects and/or controls, reach with hands and arms, climb stairs, balance, stoop, kneel, crouch or crawl, talk or hear, taste or smell. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by the job include vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust to focus. High stress department requires excellent stress management techniques. Employee must be able to understand and have compassion to deal with possible irate and/or out of control patients and/or families.
Qualifications & Skills: a) Education: High school graduate or equivalent.

b) Training & Experience: 2 years hospital PFS department experience with a broad knowledge of hospital billing, collections and payment application for commercial insurances.
c) Knowledge: Typing-keyboarding skills required. Computer literate. Good communication and interpersonal skills. Works well with the public. Medical terminology knowledge. Familiar with insurance processing. Coding training and certification preferred.
d) Possesses good communication skills, good listener and maintains a positive attitude.
e) High level of organizational skills, time management skills, be able to multi-task and prioritize, focus on quality.

f) Self-starter/initiative.

g) Must be flexible and able to work in a fast-paced environment.

h) Enjoys interaction with the public and demonstrates the ability to develop and foster relationships.




Job Snapshot

Employee Type

Full-Time

Location

Montrose, CO

Job Type

Insurance

Experience

2 years

Date Posted

04/07/2023