Description
Claims Accounting Research Technician
Department: Claims & Accounting
Description:
Responsible for accurate and complete research, recording and processing of returned and refund checks in conjunction with recovery activities, and in accordance with department procedures.
Perform a quality review of claim, EOB, and cash receipts to determine final disposition in claim system. Analyze and interpret provider contracts and accounting transactions by analysing recoupments, advance pay and recoveries.
Researches and reissues checks associated with returned/canceled/lost/reissued checks.
Makes members/providers and their needs a primary focus of one's actions; develops and sustains productive member/provider relationships.
Accurate and complete research, recording and processing of returned and refund checks in conjunction with collection and recovery activities, and in accordance with department procedures.
Research and resolve Unclaimed Property.
Perform Daily reconciliation of bank reports and validate EOB/SOR Release.
Daily import from Lockbox to validate daily deposits and supporting documentation.
Respond to inquiries initiated in CMIL or CHATS that may include adjusting or voiding the check and the claim, placing a stop pay or void on a provider check, and contacting providers for Stale Dated Checks. Notify the adjudicators about claims that need to be reprocessed.
Advise Claims Configuration about provider and member address changes.
Prepares documentation for review by Supervisor or Manager as required.
Actively seeks information to understand member/patient circumstances, problems, expectations, and needs.
Build rapport and cooperative relationship with providers and other departments.
Considers how actions or plans will affect members; responds quickly to meet member and provider needs and resolves problems.
Responsible for non-routine Claims Department activities including, but not limited to, resolving large provider claims issues, recovery of funds from providers made in error and the adjustment of provider claims due to incorrect payments.
Candidate should have a thorough understanding of all aspects of medical claims processing including auditing and cash posting.
Experience must be on an automated system, including processing of payments, using medical terminology, CPT, ICD-9, ICD-10, HICFA and UB92 coding for both Medicare and non-Medicare claims, and working knowledge of other insurance benefit plans including coordination of benefits and workers compensation.
Must be able to work in a Labor Management Partnership environment.
Demonstrated customer service skills, customer focus abilities, and the ability to understand customer needs.
Performs other duties as assigned by management.
Top Daily Responsibilities:
1) Perform research on claims inquiries and reprocess claims as needed
2) Recover funds from providers due to overpayment, and adjust provider claims for overpayment and/or underpayments
3) Assist in system issues eg contract and benefit terms, edits
Requirements:
Minimum 3-4 years of processing medical claims including POS, PPO, HMO, Medicare, Deductible & Coinsurance of which 2 years would be in research and/or QA processing experience, preferably in Healthcare.
AA Degree in Accounting, Business, or related required
Must have a thorough understanding of all aspects of medical claims processing including auditing and cash posting.
Experience must be on an automated system, including processing of payments, using medical terminology, CPT, ICD-9, ICD-10, HICFA and UB92 coding for both Medicare and non-Medicare claims, and working knowledge of other insurance benefit plans including coordination of benefits and workers compensation.
Effective communication skills required.
10 key by touch required.
Requires PC terminal skills in a windows environment and demonstrated Intermediate skills in Excel, Access and math.
Demonstrated customer service skills, customer focus abilities, and the ability to understand customer needs.
Top Required Skills:
1) Ability to research claims at all levels of complexity in an accurate and timely manner
2) Understanding of coordination of benefits, co-insurance and high deductible plans
3) Health care insurance and medical coding, billing and payment guidelines