Insurance Claims Analyst (Full-Time, Mon-Fri 8A-4:30P)

Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400 team members and serve the region with over 45 clinic locations, the areas only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

Position Summary

The role of the Insurance Claims Analyst reports to the corresponding Insurance Billing Manager. This position is responsible for providing exceptional billing and AR follow up of Washington Regional Hospital and Clinic claims. This position oversees research and resolution of insurance billing issues at the time of claims submission, receipt of denial or non-contracted payment, and refund requests. This position must have the ability to learn and understand multiple software systems.

Essential Position Responsibilities

• Review and research insurance denials receive through insurance remittances, payor correspondence, or Clearinghouse rejections in an accurate and timely manner

• Respond appropriately to payor denials through written and/or verbal appeals processes for payor specific denials
• Provide effective communication with patients, insurance companies, and staff
• Maintain AR collection of claims at less than 30 days of account age
• Collaborate with necessary departments to ensure overall account accuracy and issue resolutions
• Reconcile transactions to ensure payments are balanced
• Provide timely and efficient follow-up on all outstanding AR using assigned ATB worklist reports, using various systems including: Payor portals, Payor phone inquiries and/or written communications
• Assigned to specific insurance(s) and providers/specialties but expected to learn on the job other insurances and specialties for career growth
• Maintain current assigned insurance(s) guidelines, policies, and procedures related to payment of claims

Qualifications

• Education: High School graduate or GED
• Licensure and Certifications: N/A
• Experience:
  • Previous billing and claims experience within a hospital and/or clinic business office with 2 year experience, preferred.
  • Basic working knowledge of the MS Office suite of software, and the ability to operate standard office equipment.
  • Broad knowledge of medical terminology, medical collections, MS-DRG coding methodology, ICD-10 and CPT coding, preferred.

Work Environment: This position will spend 80% of time sitting while performing work in a standard office environment and 20% of time standing and/or walking while pushing, pulling, lifting, and/or carrying up to 50 lbs.