- Job ID
- Regular Full-Time
Under general supervision, adjudicates behavioral health, medical claims entered into the CPI EHR system for all lines of business. Reviews and resolves rejected, pended and/or denied encounters within the claims system timely. Organizes claim and encounter data and prepares various claims/encounter reports; conducts research and analyses of encounter and claims data; facilitates resolution of specific claims and encounter issues; serve as liaison to internal department, payers and external agencies.
DUTIES AND RESPONSIBILITIES:
- Processes claims and encounters within the specified Revenue Cycle Management time established.
- Creates 837 files and uploads to Clearinghouse.
- From Clearinghouse downloads 277 files, reviews and resolves claim rejects.
- From Clearinghouse downloads 835 files and posts to CPI EHR system.
- Review and resolve pended and/or denied claims within the CPI EHR system
- Maintains productivity and quality standards as determined by the department.
- Identifies and Coordinates any claims processing system issues, and reports to supervisor.
- Responds to calls on claim issues and provides information and resolution.
- Provides customer service to contracted prayers to assist with the resolution of pended or denied claims/encounters.
- Produces scheduled reports for in-house departments.
- Prepares written inter-departmental and external correspondence.
- Analyzes encounter-processing data using statistical methodologies.
- Responsible for following any policies, procedures, and controls established by the organization, the HIPAA Privacy Officer, and/or the HIPAA Security Officer regarding access to, protection of, and the use of the PHI.
- Performs other duties as assigned.
Training or experience equivalent to a bachelor’s degree plus three years experience in claims analysis and adjudication of medical claims, including Medicare and Third Party Liability. Experience with ICD10, CPT, HCPCS and UB04 coding and billing and knowledge of HIPAA regulations is required. Advanced knowledge of Microsoft Excel and 10-key by touch is also required.
- Ability to operate personal computer and telephonic communications equipment
- Ability to read handwritten and printed documents and records
- Ability to perform analysis of information
- Ability to move around an office environment
- Ability to communicate verbally and in writing
- Ability to read the screen of a personal computer monitor