Claims Research Analyst (MedStar Physician Billing Services)
Job SummaryAnalyzes invoice with no adjudication status to facilitate timely reimbursement for 1 billion + annual billing of provider services. Reviews, researches, and corrects TES edits, eligibility and registration corrections. Ensures that claims meet billing guidelines for assigned carriers. Uses GE IDX ETM to ensure the claims status is changed to ensure successful resubmission in a timely manner.Minimum QualificationsEducation/TrainingHigh School Diploma or equivalent.Experience1 year in medical billing environment. GE IDX experience preferred.License/Certification/RegistrationNo special certification, registration or license required.Knowledge, Skills & AbilitiesKnowledge of accounts receivable practices. Strong organizational skills with the ability to process high volume services, with accuracy on a daily basis. Skills in using computer and calculator. Ability to examine documents for accuracy and completeness and prepare claims and other records according to detailed instructions. Ability to work and thrive in team oriented, production and deadline driven work environment. Verbal and written communication.Primary Duties and ResponsibilitiesContacts third party payers as needed to resolve billing problems/claims processing delays.Exemplifies Guest and Staff Relations standards in all activities in areas of service, resource utilization, high quality outcomes and effective communication and holds staff accountable for conformity with those standards in all activities.Maintains billing manuals and reference documents for assigned third party carriers.Participates in educational/professional development activities.Processes high volume claim submissions with an error rate of 10% and less.Recommends and assists in implementation of manual and automated billing processes to enhance claim generation and submission process.Researches and requests necessary billing information and documentation from provider/division billing contact/patient.Resolves all No Activity invoices accurately and in a timely manner.Responds to incoming mail from insurance carriers.Reviews and resolves claim issues such as edits and registration edits in a timely manner.Reviews claim forms to meet billing requirements as dictated by third party payers.Reviews, processes, or reassigns appeals, charge correction, coding and provider enrollment rejections as required to achieve successful claim reimbursement.Serves as resource to others related to assigned insurance carriers as needed.Updates accounts in billing system.Contributes to the achievement of established department goals and objectives and adheres to department policies, procedures, quality standards and safety standards. Complies with governmental and accreditation regulations.Participates in multidisciplinary quality and service improvement teams as appropriate. Participates in meetings, serves on committees and represents the department and hospital/facility in community outreach efforts as appropriate.Performs other duties as assigned.