CLARION HOSPITAL Insurance Claims Representative Salary in the United States

CLARION HOSPITAL

                                                                JOB DESCRIPTION

Job Title:  Insurance Claims Representative                            FLSA Status:  Non-Exempt

Department:  Patient Accounts                                                    Job Code: 1047

                                                                                                            Revised Date: 10-27-14

Summary of Responsibilities:

The Insurance Claim Representative is expected to demonstrate through plans and actions, that there is a consistent standard of excellence to which all work is to conform.  Such a standard should be based upon establishing and maintaining a constancy of purpose, focusing on continuous improvement within the scope of the key responsibilities.

The job description/performance evaluation is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.  Employees will be required to perform other job-related instructions given by their supervisor, subject to reasonable accommodations.

Key Responsibilities:

Reviews and prepares claim processing to third party payers

Prepares and submits electronic submission of claims transmission daily

Prepares and submits non-electronic submission of claims transmission daily

Processes verification of claims accuracy on electronic billing system

Processes verification of claims transmitted from electronic billing system

Produces and executes file creation and tracking of claim processing data

Processes and assists in preparing appropriate documents such as spreadsheets for cost reporting purposes

Requests accurate adjustments with supporting documentation

Requests refunds to insurance carriers and patients

Executes and produces claim follow up to include secondary billing processes

Submits claims to secondary payers

Responds to insurance carrier requests

Responds to patient’s inquiries when needed

Processes accurate charge correction and claim adjustments

Possesses the ability to appropriately identify and update claims in hospital system

Misc. Claims processing, communication and file maintenance of claims

Possesses the ability to communicate using electronic media to multiple entities

Processes and completes reports/duties assigned

Communicates with other departments to ensure correct and accurate billing processes.

Communicate, participate in training and development on the processes and related industry knowledge required to perform with a high degree of accuracy and timeliness.

Maintain all updates related to performing the job functions with comprehensive information for any changes on industry regulations and payer requirements associated with the function.

Ensure a high degree of customer service in the interaction with both direct and indirect customers in the completion of the functions.

Responsible for managing processes established for the identification, communication and collection of patient liable balances and referring cases for financial counseling as appropriate.

Monitor outcomes for compliance with process and policy, and customer service so to provide periodic feedback for reinforcement of compliance and corrective action for deficiencies.

Identify process deficiencies or improvements and make recommendations to the Insurance Claims Supervisor for standard changes that will improve the performance of the represented hospital and/or pod hospitals.

Performs other duties and activities necessary to support the needs of the hospital and RC Pod operations;

Completes hospital initiatives as they apply to the department.

Participates in meetings and other methods of communication needed to determine root cause of issues and recommends corrective actions to the Insurance Claims Supervisor for process standardization.

Assists in performing system configuration and table maintenance of the assigned systems.

Performs system testing of updates and releases within the functional scope as assigned.

Completes other duties as assigned.

Qualifications:

EDUCATION:  High school diploma is required.  Some advanced education is desired.

EXPERIENCE: At least 3 years of clerical experience is preferred.  Computer skills required.  Previous hospital insurance billing experience with the last six months preferred.

SPECIAL REQUIREMENTS: Cheerfulness, patience and tact in dealing with patients, physicians, and other employees are essential.  Strong professional verbal communication skills required.

JOB KNOWLEDGE:  Thorough understanding of insurance billing and regulations to produce compliant data to insurance carriers, employers and patients is required.

WORKING CONDITIONS:  Works in well-lit, temperature controlled environment.  No hazards associated with the job.

OTHER REQUIREMENTS:  Need the ability to promote change through teaching and persuasion, and instill confidence through subject matter expertise.

PHYSICAL DEMANDS:  Sits or stands most of the day.  May walk short distances between departments.  Required to lift approximately 18 pounds (Computer paper).  Requires fine motor and gross motor skills to complete the job. Typing is required less than 25% of the total work time for one shift.  Single key stroke is required for approximately the same amount of time.

The intent of this job description is to provide a representative summary of the major duties

and responsibilities performed with or without reasonable accommodations by incumbents of this job.  Incumbents may be required to perform job-related tasks, duties, and/or responsibilities other than those specifically presented in this description.

Reporting Relationships

Reports to: Patient Accounts Manager

Supervises:  None

Working Conditions

Generally pleasant environment.