Claims Analyst Specialist is knowledgeable of all payers. Responsible for the tracking, review and follow-up of all outstanding patient accounts. This includes but is not limited to timely review of Patient Accounting Desktop, Clearinghouse billing list and Intermediary on line error list. Contact insurance companies and patients, filing primary, secondary and tertiary insurance, re-bills, and review payment remittance. Review line item denials and claim rejections for possible appeal and/or research for resubmission. Be proficient in the use of multiple payer software systems. The knowledge of billing codes including CPT, ICD10, HCPCS, Modifiers, CCI Edits, MUE Edits and claim formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payers to ensure maximum cash flow. Additional responsibilities include posting payments and denials to claims filed directly to a patient’s account via electronic posting and manual batch posting. Also required to process requested adjustments, complete daily reconciliation of bank deposits and payment posting. The Claims Analyst Specialist is responsible for entering daily posting numbers to accounting shared spreadsheet, processing refunds from credit balance report and completing insurance requests to include follow up. Interact with insurance carriers in all aspects of claim resolution. Monitor and follow up Medicare and Medicaid accounts identified by recovery audit contractors (RAC). May be required to work overtime if needed.
