Commercial Claims Analyst-Non Governmental

Job Description

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.

1. 1. Paper claims with appropiate documentation are filed timely.
   2. Utilize appropriate resources to review accounts as needed for insurance verification.

1. • Proficiency and accuracy is required for all work performed on daily basis. Knowledge of different system is required.

2. Processes commercial payment vouchers timely.

1. 1. Accounts are verified for correct reimbursement with contract terms.
   2. Payments and adjustments are posted the date received.
   3. Correct plan codes are utilized for posting.
   4. Secondary payors are filed the date voucher has been received.
   5. Denials are documented.
   6. Insurance refunds are processed and docemented timely, and the appropriate action is taken.
   7. Monthly refunds are balanced with General Ledger and the AR Summary, reports are due timely.
   8. 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.
2. Traces/follow-ups on claims are accurate and timely.

1. 1. Accounts are properly documented.
   2. Claims are traced according to prioritization of timely filing limits and high dollar balances.
   3. Collection letters are utilized within the appropriate time.
   4. 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.

1. 1. Records are maintained for accurate billing and reimbursement for managed care contracts.
   2. 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.