Claims Processors

CornerStone Staffing is seeking a Claims Processor t hat has experience in processing hospital claims and manually entering claims.

We are currently seeking candidates to work for an excellent Healthcare company in Fort Worth

JOB ID - 144922

Job Title: Claims Processors

DIRECT HIRE

Pay: $20-$23/hr Depending on experience

Location: Will train on site in Fort Worth, TX MUST BE LOCAL TO THE AREA Then will move 100% remote after 1-2 weeks.

Hours: Flexible to work any 8 hour shift between Monday - Friday, 8am-6:30pm

Job Description: The Revenue Cycle Analyst is responsible for analysis and monitoring of claims audit data across multiple platforms. Performs various follow-up activities to ensure the accuracy and appropriateness of reimbursement made to healthcare providers. Responsibilities include identifying payment variances and working internally and externally to resolve such issues. MUST HAVE CLAIMS PROCESSING EXPERIENCE.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES:

Identifies errors in reconciliation files across multiple work streams and business units for multiple sites and with external partners.

Performs contract and reimbursement variance analysis.

Analyzes claims data to identify contractual over payments and billing errors.

Assists department and leadership in obtaining complex information from various financial, clinical and operational systems and data sources.

Establishes and maintains detailed knowledge and documentation of all analysis/data sources within the department.

Analyzes all forms of Revenue Cycle transactions.

Possesses the ability to run standard Revenue Cycle and operations reports in order to answer questions from department/practice managers, vendors, physicians, and other Revenue Cycle stakeholders.

Produces daily, monthly and annual evaluative and statistical reports, analyzing drivers of variances from period to period in order to ensure the integrity and accuracy of revenue cycle data.

Evaluates integrity of client data including actively participating with and supporting the Product and Account Management teams with trend analysis of payment and data variances.

Ensure strict confidentiality of all medical records, PHI, and PII.

Must have experience in processing hospital claims and manually entering claims. Also must have knowledge of understanding of how to read a contract.

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting hospital and physician claims

• Reprice bills according to the physician/facility contracts

• Recent work history that supports excellent organization, problem-solving communication, teamwork, and interpersonal skill

• Authorize the appropriate payment or refers claims to investigators for further review

• Conduct data entry and re-work; analyzes and identifies trends and provides reports as necessary

• Analyzes and adjusts data, determines appropriate codes, fees and ensures timely filing and contract rates are applied.

KNOWLEDGE & SKILLS:

Ability to work independently and use critical thinking.

Detailed knowledge of pay reimbursement methodology for

Detailed knowledge of CPT, HCPCS, revenue codes and ICD-10 CM.

MS Office including Word, PowerPoint, Excel and Outlook; Windows operating system and Internet.

Strong analytical and problem solving skills

23

EDUCATION/EXPERIENCE:

3+ years of relevant experience or equivalent combination of educations and work experience.

High School Diploma or equivalent required