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Job ID: 59163
Location: Granite Falls, NC
Facility/Division: Caldwell Memorial Hospital
Status: Full Time
Shift: Day Job
Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.
Reviews, verifies, edits and submits/transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies. Assures claim and data submission is timely, accurate and compliant with third party payor requirements and federal and state regulations. Reviews third party payor payments, explanations of benefits/payments and other correspondence received to assure accurate processing has occurred. Initiates corrective action as indicated.
Description of Job Responsibilities:
1. Reviews, verifies, edits and submits/transmits claims and claim data to third party payors, insurance carriers, federal and state governmental agencies. Assures claim and data submission is timely, accurate and compliant with third party payor requirements and federal and state regulations. Reviews third party payor payments, explanations of benefits/payments and other correspondence received to assure accurate processing has occurred. Initiates corrective action as indicated.
2. Communicates with billers, managers, and registration staff to troubleshoot problem claims, gather additional information or make corrections for billing.
3. Tracks patient and insurance credit balances, to ensure that all credit payments are zeroed out by end of quarter.
4. Manages workflow in order to maximize the volume of claims corrected and filed.
5. Communicates with the Operations Manager to provide potential solutions on a system level to prevent failed claims.
6. Reviews daily encounter forms to ensure that charges seem reasonable and have been put on the correct visit.
7. Reviews vaccination charges on daily charge entry, to ensure proper state or private coding.
8. Communicates with staff regarding authorization information; enter all authorization information into patient file and maintain patient billing/authorization file updates.
9. Communicates with insurance companies to obtain patient eligibility, benefits, co-pays, policy restrictions; obtains all billing requirements (type of bill, CPT codes); ; communicate with Insurance case managers and staff regarding authorization information; enter all authorization information into patient file and maintain patient billing/authorization file updates.
10. Responsible for advising management when rate changes are warranted.
11. Serves as primary contact for Payor Path equipment issues; troubleshoots professional staff daily Payor Path issues; Works with vendor Help Desk to resolve issues.
Education Requirements: High school diploma or general education degree (GED) required. Bachelor's degree preferred.
Licensure/Certification Requirements: None required.
Professional Experience Requirements: Two years of office management in a health care setting. Computer skills required, with Microsoft Word and Excel experience preferred.
Knowledge, Skills, and Abilities Requirements: Language Skills: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, federal, state and third party claims processing requirements and regulations and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and to draw and interpret bar graphs.
COMPUTER SKILLS: Ability to use hospital and medical claims processing software. Working knowledge of Word, Excel, Schedule Plus, and Microsoft Exchange. Proficient keyboarding skills. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form.
Legal Employer: NCHEALTH
Entity: Caldwell Memorial Hospital
Organization Unit: PSS Operations
Work Type: Full Time
Standard Hours Per Week: 40.00
Work Schedule: Day Job
Location of Job: US:NC:Granite Falls
Exempt From Overtime: Exempt: No
This position is employed by NC Health (Rex Healthcare, Inc., d/b/a NC Health), a private, fully-owned subsidiary of UNC Heath Care System. This is not a State employed position.
Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
UNC Health makes reasonable accommodations for applicants' and employees' religious practices and beliefs, as well as applicants and employees with disabilities. All interested applicants are invited to apply for career opportunities. Please email [email protected] if you need a reasonable accommodation to search and/or to apply for a career opportunity.
The UNC Health System and the UNC School of Medicine are committed to valuing all people throughout our organization, regardless of background, lifestyle, and culture. A diverse and inclusive work environment for staff and culturally appropriate care for our patients, are essential to fulfilling our UNC Health vision of improving the health of all North Carolinians.
UNC Health is an equal opportunity and affirmative action employer.
Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation.
All interested applicants are invited to apply for career opportunities. Please refer to our Employment Application Accessibility page if you need a reasonable accommodation to search and/or to apply for a career opportunity.
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