Claims Processor

Overview

• THIS CAN BE A REMOTE OPPORTUNITY **
  
  
  

CHI Health strives to care for you the way you care for your patients.

We understand you have personal responsibilities outside of your profession and also care about your well-being.

With you in mind, we offer the following benefits to support your work/life balance:

• Health/Dental/Vision Insurance
• Direct Primary Plan (No copay, no deductible, and access to CHI Health provider 24/7)
• Premium Access to our Family Care Program supporting your needs for childcare, pet care, and/or adult dependent care
• Voluntary Protection: Group Accident, Critical Illness, and Identity Theft
• Employee Assistance Program (EAP) for you and your family
• Paid Time Off (PTO)
• Tuition Assistance for career growth and development
• Matching 401(k) and 457(b) Retirement Programs
• Adoption Assistance
• Wellness Programs
• Flexible spending accounts
  
  
  

From primary to specialty care as well as walk-in and virtual services CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours.

Responsibilities

Job Summary / Purpose

This job is responsible for submitting claims in accordance with payer regulations and applicable guidelines. An incumbent will facilitate the overall claim process through submission of both electronic and paper-based claims, resolution of claim-form edits and validation of data integrity.

Work requires an understanding of detailed billing requirements, claims attachments and claim rejections, as well as attention to detail, the ability to accurately and timely troubleshoot/resolve questions/issues and to resolve (within scope of the position) issues which may have a potential impact on revenues.

Essential Key Job Responsibilities

• Transmits/retrieves electronic patient claims/files to and from the claims clearinghouse in accordance with established procedures.
• Reviews claims for all necessary requirements for billing, including complete patient and insurance information; completes paper claim processing in a timely and accurate manner.
• Resolves all claim edits, in both the billing system and the clearinghouse, accurately and timely through attention to detail and critical thinking skills in accordance with payer regulations and guidelines.
• Identifies and researches unusual, complex or escalated issues as assigned; applies problem-solving and critical thinking skills as necessary to resolve issues within the scope of position authority.
• Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
• Maintains current knowledge of internal, industry, and government regulations as applicable to assigned function.
• Other duties as assigned by management.
  
  
  

Qualifications

Minimum Qualifications

Required Education (for CHI Leadership Job Levels from Supervisor through President)

Does Not Apply

Required Education For Staff Job Levels

NA

Required Licensure And Certifications

NA

Required Minimum Knowledge, Skills And Abilities

• Knowledge of general concepts and practices that relate to the healthcare field, and specific policies, standards, procedures and practices that pertain to the assigned function.
• Knowledge of medical insurance, CPT and ICD codes.
• Knowledge of clinic operations related to patient registration, referrals and cash collections.
• Knowledge of general office principles, practices, standards, systems and tools/equipment.
• Knowledge of medical insurance, payer contract, and basic medical terminology and abbreviations.
• Knowledge of the regulatory/reporting requirements that pertain to the assigned function.
• Knowledge of sources and availability of information relevant to the assigned function.
• Knowledge of the operation and application of automated systems applicable to the assigned function.
• Ability to enter data in accordance with established standards of timeliness, accuracy and productivity.
• Ability to understand and apply detailed billing requirements and insurance follow-up practices.
• Ability to keep abreast of trends, developments and changing regulatory requirements that impact matters within designated scope of responsibility.
• Ability to identify and articulate non-compliance with established guidelines and/or regulatory requirements.
• Ability to troubleshoot, understand and/or adapt moderately complex oral and or written instructions/guidelines to diverse or dissimilar situations.
• Ability to maintain confidentiality of medical records, and to use discretion with confidential data and sensitive information.
• Ability to demonstrate attention to detail and critical thinking skills within the context of the assigned function, with a commitment to accuracy.
• Ability to effectively prioritize and execute tasks while under pressure.
• Ability to make decisions based on available information and within the scope of authority of the position.
• Ability to demonstrate excellent customer service skills, including professional telephone interactions.
• Ability to read, understand and communicate in English sufficient to perform the duties of the position.
• Ability to establish and maintain effective working relationships as required by the duties of the position.
• Ability to use office equipment and automated systems/applications/software at an acceptable level of proficiency.
  
  
  

PREFERRED Qualifications

Graduation from a post-high school program in medical billing or other business-related field is preferred

High School Diploma Or GED Preferred

Pay Range

$17.89 - $24.60 /hour