Full-time Claims Analyst-Patient Accounting

At Ashe Memorial Hospital, we are driven by our Mission Statement, "To meet the needs of the community by delivering patient-centered, high quality health care."

 

Ashe Memorial Hospital is proud to be Voted Ashe's Best Place to Work 2022, 2023,2024, & 2025. Come be a part of our dynamic team; you'll join Ashe's 2022 & 2023 Best Hospital, Best Surgeon, Best Physician, Best Nurse, and Best Medical Practice!  This is your opportunity to make a large difference in a small community!

Hours: 1st shift, Mon-Fri  | No Supervisory Responsibilities | No Travel | Pay commensurate with experience

Full time, day shift in Patient Accounting.

JOB SUMMARY:  

 

The Claims Analyst is responsible for tracking, reviewing and follow-up of all outstanding patient claims.  The follow-up includes researching denials and rebilling when appropriate until all payments have been remitted by payors.  This includes a timely review of account reminders.  Claims Analyst contacts payors, files primary, secondary, and tertiary insurance, rebills, and reviews payment remittances.  Reviews denials and claim rejections for possible appeal and/or research for resubmission.  ensuring accuracy, compliance with regulations, and proper reimbursement. This role supports the financial integrity of the hospital by identifying discrepancies, preventing fraud, and optimizing claims workflows.  Must be proficient in the use of multiple payor software systems and possess knowledge of billing coding, including CPT, ICD10, HCPCS, modifiers, CCI edits, MUE edits, and claims formats. The ultimate result of these efforts should facilitate complete and prompt payments from third party payors to ensure maximum cash flow.  Interacts with patients and staff in a professional manner, promotes teamwork, and creates an environment where a positive patient experience is a requirement.  

Minimum Job Qualifications: 

 

Education:  

• High school diploma or general education degree (GED) required. 

• Post high school courses in insurance billing, data processing, and medical terminology preferred. 

 

Experience:   

• 1 year of experience in computerized third-party billing of facility and/or professional services required. 

• Knowledge of third-party billing requirements required. 

• 2 years of previous hospital business office experience preferred. 

• 1 year of experience with Meditech and/or SSI preferred. 

License/Certifications: N/A 

ESSENTIAL FUNCTIONS: 

 

• Teams with the leadership to ensure that system deficiencies are eliminated through claim checks, dictionary changes/updates (if applicable), and/or service requests.  

• Actively participates in ensuring that processes are effective and efficient and prevents minimizing the likelihood of denials. 

• Follow up with third-party payors on unpaid claims until claims are paid or only true self-pay balances remain. 

• Research rejections and denials, rebill corrected claims. 

• Forward claims for additional appeals or reconsiderations to appropriate team members. 

• Prepares and submits secondary and tertiary claims to payors for payment either electronically or via paper per the payor’s requirements. 

• Keeps updated on all third-party billing requirements including HMP/PPO, Medicare, and Medicaid. 

• Maintains confidentiality. 

• Supports the hospital and promotes a positive attitude. 

• Adheres to dress code, appearance is neat and clean. 

• Wears identification while on duty.