The Physician Insurance Analyst 3 performs the duties of a Physician Insurance Analyst 1 and 2 while taking ownership for the timely and accurate editing, submission, and/or follow-up of assigned claims in order to meet expected productivity and quality standards on a weekly basis. Processes claims for all payer types (e.g. Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Processes payer response/rejection reports timely while meeting departmental productivity and quality review standards, all while identifying and reporting trends and assisting in the development and deployment of training relative to trends.
Job Responsibilities
- Ensures that all clean claims are submitted the day they are received, via the appropriate medium and with all required attachments.
- Provides resolution for pending claims within allowable timeframes, as defined for appropriate deficiency, and/or provides appropriate account follow-up based on established System Response Guidelines and Matrix.
- Resolves basic issues either through individual actions or by seeking assistance and direction from management.
- Meets productivity and quality expectations weekly for assigned work lists and any supervisor-assigned special tasks.
- Correctly completes write-off requests and submits them daily for supervisor review.
- Documents and reports claims submission issues immediately and provides feedback to management.
- Ensures that payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards.
- Identifies issues with payer rejections and provides feedback regarding rejections to management.
- Maintains knowledge of payer requirements, 1500 standards, and system (e.g. vendor, clearinghouse, payer) functionality and policies/procedures.
- Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence. Completes all assigned Epic billing/claim edits and ensures all required reports are filed timely and accurately.
- Ensures documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
- Ensures that all daily, weekly, and monthly reports are completed, submitted timely, and with minimal errors.
- Works all assigned Epic billing and claim edits, and/or follow-up needs, daily.
- Identifies opportunities for Revenue Cycle performance improvement based on regulatory, payer, physician, departmental, and/or multiple specialty service line analysis (e.g. Neurology, Cardiology, Oncology, Behavioral Health, Neurosurgery, Orthopedic, and General Surgery).
- As needed, travels to Inova sites/offices to print claims and attachments for submission to insurance payers.
- Demonstrates ability to effectively use and navigate all payer portals.
- Attends and actively participates in team meetings and huddles.
- Works on special projects related to claims and denials follow-up, and may perform other additional duties as assigned.
Additional Requirements
Experience: Two years of experience in Revenue Cycle operations, billing, collections, cash posting and/or administrative support in physician billing.
Education: High School or GED.
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