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Claims Analyst | Home Plus Pharmacy-Specialty | Full Time
4 months ago
Current Employees:
If you are a current employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage.
Primary Location
Rapid City, SD USA
Department
Home Plus RC Pharmacy-Specialty
Scheduled Weekly Hours
40
Starting Pay Rate Range
$16.40 - $20.50
(Determined by the knowledge, skills, and experience of the applicant.)
Job Summary
Performs those duties necessary to ensure the proper interpretation, processing, recording, approval and payment of inpatient and outpatient medical claims. Accurately reviews information for processing claims into a computerized system in accordance with the primary payer specifications and billing guidelines.
Monument Health offers competitive wages and benefits on qualifying positions. Some of those benefits can include:
*Supportive work culture
*Medical, Vision and Dental Coverage
*Retirement Plans, Health Savings Account, and Flexible Spending Account
*Instant pay is available for qualifying positions
*Paid Time Off Accrual Bank
*Opportunities for growth and advancement
*Tuition assistance/reimbursement
*Excellent pay differentials on qualifying positions (extra pay for working evening, nights or weekends)
*Flexible scheduling
Job Description
Essential Functions:
- Conducts timely follow up of claims as needed.
- Demonstrates application of compliance standards and payer specific data to properly file claims, ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback.
- Demonstrates a working knowledge of third party payor procedures including, but not limited to; Medicare, Medicaid, Champus, Blue Cross and all other third party contractual agreements entered into.
- Uses tools provided to track and trend patterns of claim submission issues that might require Compliance and Charge master staff to resolve, or HIPAA transaction code set review. Research payor requirements and offer suggestions to leadership for claims submission issues.
- Maintains and updates appropriate system documentation to provide information regarding claim processing to internal or external customers.
- Identifies unresolved requests of patient responsibility and transfers account to self pay. Performs duties and provides best customer service using behaviors that demonstrate responsibility and accountability.
- Participates in departmental activities related to performance improvement and quality control.
- All other duties as assigned.
Additional Requirements
Preferred:
Experience - 1+ years of Clerical Experience; 1+ years of Medical Patient Accounts/Financial Services Experience
Education - Bachelors degree in Accounting, Business, Health Related Field
Certifications - Certified Clinical Account Technician (CCAT) - Accredited University or accredited training professionals; Certified Patient Account Technician (CPAT) - Accredited University or accredited training professionals
Physical Requirements:
Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time.
Job Category
Revenue Cycle
Job Family
Patient Financial Services
Shift
Employee Type
Regular
40 Monument Health Home Plus
Make a difference. Every day.
Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.
