Required Education and Experience: High School graduate or equivalent required. Two years experience in a related field preferred. Medical Health Insurance experience required.

Additional Eligibility Qualifications: Aptitude to retain detailed information. Must possess the ability to work within general and plan guidelines. Ability to prioritize and be able to produce an acceptable volume of work. Possesses good problem-solving skills. Have mathematical aptitude and an ability to concentrate on details is necessary. Excellent organizational skills. Ability to assess a situation and decide best course of action. Excellent communication skills, oral and written. Be able to communicate ideas in a clear and concise manner. Use inter-personal skills effectively to communicate with internal and external customers to resolve payment issues. Basic knowledge of Windows based computer applications. Be able to operate the following equipment: computer, copier, fax and 10-key calculator. Professional appearance and manner.

Essential Functions
Posts insurance payments/rejections to the account receivable in the IDX system in a timely manner. The acceptable standard of production is no less than 8,000 transactions per month.

Reviews EOB’s being posted closely to ensure that all items are being posted accurately (i.e., correct date of service, correct allowable, non-covered items, patient responsibility). Verifies that payment is correct according to our individual contract with specific carriers, and correct contractual adjustments are done only against contracted carriers. Enters the LA (Low Allowance) FSC on line item when not paid per our contracted rate. An acceptable standard error rate has been established of no more than 3% per month.

Splits invoice if carrier is paying part of the invoice and there is patient responsibility left on these charges.

When an EOB is received from a contracted carrier and the invoice is sitting in a self-pay, NOI or commercial FSC, it is necessary to do a charge correction before posting the payment and doing a contractual adjustment. A form is prepared and given to a designated person for them to do the charge correction before the payment is posted to the system.

Posts any payments to the “unidentified, insurance” account after calling the carrier for help in identifying. Makes a copy of EOB and files in the appropriate month folder to be worked later by assigned individual.

Generates and accurately balances the batch log sheet on a rotating basis.

Does appropriate follow-up on the unidentified account as assigned.

Adheres to guidelines set by the Clinic’s Compliance Program, following all Health Care Regulatory Laws on medical coding, billing and reporting of compliance issues. Maintains confidentiality of Clinic materials. Refrains from discussing or releasing confidential information except with individuals legally entitled to such information and as specifically authorized for release.