Commercial Claims Analyst-Non Governmental

Description

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina.

Summary:

Expedites the settlement of insurance claims by submitting accurate claims in a timely manner.

Responsibilities:

• 1. Files insurance claims in an accurate, timely manner within 1 day from billed date.
• a. Paper claims are utilized when necessary.
• b. 5020's are obtained and kept on file daily and necessary information is added to accounts for billing purpose.
• c. Utilizes electronic billing system for submission of claims
• d. Transactions are posted correctly to utilize the correct transaction codes
• Paper claims with appropriate documentation is filed timely

2. Review claims and contract data frequently.

• Verify provider numbers and review regulations & guidelines
• Follows proper procedure for outpatient accounts.
• Process and respond to correspondence

3. Processes appropriate vouchers and documents.

• Adjustments totals are corrected and verified in both systems timely.
• Appropriate paperwork is forwarded to Finance.
• Denials are worked timely and accurately
• Accounts are verified for correct reimbursement
• Resubmits denials within 5 days of posting
• Payments and adjustments are posted date received
• Denials are documented
• Refunds are processed timely
• Accounts are reclassified to reflect payments/denials for collections activity
• Monthly refunds are balanced with the General Ledger and the Account Receivable Summary, reports are timely

4. Trace/follow-up on claims accurately

• Accounts are traced timely and accurately
• Accounts are documented within the Meditech system
• All high dollars accounts are reviewed and followed up on in a timely manner
• Intellect accounts are completed timely
• Phone, written and electronic inquiries completed with 30 days of billed date
• Collection letters are utilized within the appropriate time

5. Reconciliation reports are processed & analyzed monthly.

• Total Charges and Payment Variances are reconciled
• Excel worksheets are utilized for reconciliation
• Monthly totals are verified for accuracy and corrections are posted in Meditech and/or Cirius.

6. Reviews relevant publications

• Reviews monthly publications
• Changes are referred to Supervisor
• Attend seminars as needed

• EDUCATION
• High school diploma or equivalent required.
• EXPERIENCE
• Minimum 1-year experience working with insurance related field preferred. Computer background required. Basic knowledge of Federal and State healthcare regulations required. Knowledge of Manage Care contracting terms, Commercial payors and/or Blue Cross and Blue Shield Contracts and benefits preferred.
• LICENSURE/REGISTRATION/CERTIFICATION
• None.
• OTHER SKILLS AND QUALIFICATIONS
• Excellent organizational and analytical skills required. Proficient written and oral communication skills. Ability to utilize personal computer and programs, electronic calculator, and other office equipment. Strong accounting background and Medical terminology preferred. Excellent customer service skills required. Knowledge of computer software, Excel, Word, etc. Experience with the Meditech computer system desired.

Legal Employer: Lenoir Health

Entity: UNC Lenoir Health Care

Organization Unit: Patient Accounting

Work Type: Full Time

Standard Hours Per Week: 40.00

Work Assignment Type: Onsite

Work Schedule: Day Job

Location of Job: LENOIR MEM

Exempt From Overtime: Exempt: No

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.