Catholic Health Initiatives Claims Processor in OMAHA, Nebraska

Claims Processor

Description

JOB DESCRIPTION POSITION SUMMARY

This job is responsible for submitting claims in accordance with payer regulations and applicable guidelines. An incumbent will facilitate the overall claim process through submission of both electronic and paper-based claims, resolution of claim-form edits and validation of data integrity.

An incumbent also serves as a resource to other staff and departments for clinic billing through validation that proper billing guidelines are being adhered to.

Work requires an understanding of detailed billing requirements, claims attachments and claim rejections, as well as attention to detail, the ability to accurately and timely troubleshoot/resolve questions/issues and to resolve (within scope of the position) issues which may have a potential impact on revenues.

ESSENTIAL JOB RESPONSIBILITIES

Transmits/retrieves electronic patient claims/files to and from the claims clearinghouse in accordance with established procedures.

Reviews claims for all necessary requirements for billing, including complete patient and insurance information; completes paper claim processing in a timely and accurate manner.

Resolves all claim edits, in both the billing system and the clearinghouse, accurately and timely through attention to detail and critical thinking skills in accordance with payer regulations and guidelines.

Notifies Supervisor/Manager of claim edits that could be reduced/eliminated through system modifications and/or communication and feedback to the department/clinic or other areas.

Notifies Supervisor/Manager of additional claim edits that when added may reduce denials and result in prompt payment for the organization.

Notifies Supervisor/Manager of claim submission requirement changes and electronic billing errors.

Completes payer specific edits using knowledge of payer reimbursement methodologies or government regulations.

Qualifications

MINIMUM QUALIFICATIONS

Required Education and Licensure

High School Diploma or GED

Required Minimum Experience

Two years of revenue cycle or related work experience that demonstrates attainment of the requisite job knowledge and abilities.

Preferred Qualifications

Graduation from a post-high school program in medical billing or other business-related field is preferred

Job Administrative/Clerical

Primary Location NEBRASKA-OMAHA-SERVICE CENTER-SOUTH BLDG

Daily Schedule Days-Flexible

Scheduled Hours per 2-week Pay Period 80

Weekends Required Occasional

Req ID: 2018-R0170439

We’re an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.