"Medical Insurance Associate- Temporary/Part Time (5572)"

This is a temporary extra help position until position ID # SMS.CS.N7830.007 is replaced

Invoice Analyst 70%

• Establishes a process for identifying under-allowed claims using Experian Health Contract Manager and other available tools.
• Reviews and analyzes Payer EOB/Remit information to ensure appropriate payment posting.
• Verifies Payer member information, patient ID card and/or eligibility to ensure appropriate registration.
• Compiles and submits appeals to Payers using various methods.
• Identifies and compiles batch appeals by payer or network, by CPT/HCPCS/Revenue code/DRG code combination, by error type or by provider.
• Uses Contract Manager to track appeals and recoveries.
• Uses feedback and experience to continuously improve communication skills for use in preparing written and telephone appeals
• Establishes helpful and effective contacts in payer or network offices. Establishes follow-up protocol with payers and networks.
• Uses Contract Manager's functionality to prepare monthly performance statistics regarding appeals and recoveries.
• Monitors and tracks contractual, billing, registration, and posting errors, and provides continuous feedback to Management.
• Participates in meetings to discuss ongoing trends and issues regarding the administration of managed care contracts.
• Maintains the strict confidentiality required for medical records and other data.
• Participates in professional development efforts to ensure currency in managed care reimbursement trends.
• Access patient,a?c9unqn the Centricity Business billing system. Make appropriate judgement of actions taken in the billing system modules. Open, print and close batch proof; balance after daily use.
• Able to make complex decisions when resolving account under/over payments, and work independently.

Insurance Follow-up 15%

• Contact Insurance company representatives to discuss under/over payment trends.
• Able to make complex decisions when resolving accounts, take appropriate action steps to ensure proper insurance payments.
• Forward to immediate supervisor or manager if necessary. Request telephone reviews of claims if appropriate.
• Make appropriate entry of actions taken in the billing system modules.

Correspondence 10%

• Responds to complex correspondence as needed or as instructed by the Medical Insurance Assistant Manager.

Other duties as assigned 5%

• Maintain Personal Procedure Manual with current procedures for reference.

Credentials to be Verified by Placement Officer

1. High school graduation or equivalent.
2. Any one or any combination of the following, totaling six (6) months of experience in the categories below:
   1. work experience performing office/clerical activities, including use of computer systems
   2. college or university course work in any curriculum
      • twelve (12) semester hours = six (6) months