Claims Edit Specialist - Dayshift (M-F, 8a - 4:30p)

Job Details

Description

Job Summary

Supports, and is responsible for incorporating into job performance, the Frederick Health Medical Group (FHMG) mission, vision, core values and customer service philosophy and adheres to the FHMG Compliance Program, including following all regulatory requirements and the FHMG Standards of Behavior.

The Claims Edit Specialist is responsible for the management of all claims resulting from charges within the practice management system. Claims and edits management personnel are the gatekeepers of the claims process taking into consideration claims accuracy, compliance, and expedient throughput to maintain optimal performance and cash collections. Responsible for hands-on daily management of claims submission, edits, trended errors and effective communication with training staff to reduce variation, and resolve edits to clean processed claims.

Example Of Essential Functions

• Validate claims moved correctly from PM system to our clearinghouse for processing
• Review Meditech Claim and clearinghouse edits for corrections.
• Update claims with correct information and process
• Task error trends to practice personnel
• Review edits for system updates to improve system functionality
• Update payer mapping for new carriers
• Update enrollments forms as needed
• Monitor rejection dashboard
• Accept Charges for practices
• Correct PM systems edits that fail prior to entering the clearinghouse
  
  

Required Knowledge, Skills And Abilities

• Ability to demonstrate extensive knowledge of carrier rules with all government as well as commercial carriers
• Ability to maintain a high level of confidentiality.
• Must have extensive physician practice management information systems experience in applications as well as reporting
• Professional manner and attire
• Excellent oral and written communication skills
• Must demonstrate extensive knowledge of the current practice management software applications and be defined by the DRC as a “super-user” of billing and claims modules
• Must be an intermediate to extensive PC user, and be able to maintain (create, edit, professional output) Microsoft Office products efficiently (Word, Excel)
• Ability to clearly articulate administrative processes for policy implementation
• Must be able to define meaningful cause and effect situations related to claims errors at the carrier level
• Excellent communication skills, both verbal and written;
• Strong organizational skills and ability to prioritize and manage multiple tasks;
• Ability to maintain a high level of confidentiality
  
  

Minimum Education, Training, And Experience Required

• High School Diploma or GED required. Associate’s degree in business administration, or related field preferred. College courses in CPT and ICD-9 (ICD-10) coding preferred.
• Minimum of two (2) years prior physician billing experience in all aspects of central billing functions including but not limited to billing transactions and regulations, claims, insurance carriers, rejection and denial codes, error correction and re-posting and contractual adjustments.
  
  

Patient Contact

Must demonstrate and maintain current knowledge and skills in providing appropriate care/contact for patients in the following age groups:

Performance of job does not require patient contact

Physical Demands

Sedentary - Light Work - Lifting up to 15 pounds on an infrequent basis (less than one lift every three minutes). While work is mostly done sitting, a certain amount of walking or standing is often necessary.

Ergonomic Risk Factors

Repetition: Repeating the same motion over and over again places stress on the muscles and tendons. The severity of risk depends on how often the action is repeated, the speed of the movement, the required force and muscles involved.

Awkward Posture: Posture is the position your body is in and its effect on the muscle groups that are involved in the physical activity. Awkward postures include repeated or prolonged reaching, twisting, bending, kneeling, squatting, working overhead with your hands or arms, or holding fixed positions.

Working Conditions

• Bloodborne Pathogens Exposure Risk: Category C – NO exposure to blood or body fluids.
  
  

Reporting Relationship

Reports to Manager, Physician PFS

Caring for you as you care for the CommUNITY

Frederick Health offers a comprehensive and affordable benefits package. Health, Dental and Vision insurance are offered the 1st of the month after 30 days of employment to all employees hired to work at least 20 hours per week and we offer multiple plans to best meet your and your family's needs. Life insurance, Short-Term Income Replacement and Long-Term Disability are employer paid for eligible employees. Frederick Health offers a robust Paid Time Off program for eligible employees. Our 403B retirement plan helps you save for your retirement and includes an employer match to eligible employees. All employees have access to free financial planning sessions. We also offer an educational assistance program to support your education goals as well as an employer paid Employee Assistance Program.

Pay is based on experience, skills and education. If position is part-time, salary will be pro-rated based on scheduled hours. The pay range may also vary within the stated range based on specialty if applicable. Non-Exempt positions may have shift differential and/or Overtime paid, if applicable.

Hourly range: $18.61 - $27.77

Monday - Friday

Dayshift

Hours 8a - 4:30p