Clinics Analyst FT - Business Office (27797)

Essential Duties and Responsibilities:

1. Insurance Verification & Updates

   • Verify insurance eligibility and make updates as needed.

2. Claim Analysis & Submission

   • Analyze claim edits, make necessary revisions, and transmit claims.

3. Account Review

   • Review assigned accounts to ensure proper payment is received.

4. Adjustment Recommendations

   • Research and recommend appropriate adjustments for supervisor’s approval.

5. Correspondence & Re-billing

   • Handle correspondence and perform re-billing as required.

6. Insurance Follow-up

   • Contact insurance companies to inquire about the status of unpaid or underpaid claims.

7. Documentation

   • Accurately document all communications regarding accounts.

8. Independent Work & Compliance

   • Complete tasks independently while ensuring compliance with state and federal regulations, and request assistance as needed.

9. Appeals Management

   • Collaborate with NMPG staff to ensure proper handling of appeals.

10. Assistance with Financial Services

    • Assist financial service departments with duties and special projects as assigned.

11. Timely and Accurate Information

    • Provide accurate information consistently and in a timely manner.

12. Professional Assistance

    • Offer professional and courteous assistance to personnel regarding patient accounts, billing issues, and related criteria.

13. Supervisor Support

    • Respond promptly to requests for information or assistance from supervisors.

14. Financial Analysis & System Maintenance

    • Perform financial analysis and assist with file building and system maintenance as needed.

15. Other Duties

    • Perform other duties as assigned to meet hospital mission and vision.

Other Essential Functions:

1. Training & Education

   • Complete all required education, competencies, and training within assigned deadlines.

2. Attendance & Meetings

   • Regularly attend work as scheduled, be punctual, and attend department meetings.

3. Safety Culture

   • Promote a culture of safety by following safety guidelines and reporting incidents promptly.

4. Code of Conduct & Mission Support

   • Abide by the Code of Conduct and support the organization's Mission and Vision.

5. Compliance with Policies & Laws

   • Adhere to departmental and facility policies, state and federal laws, and regulatory agencies (i.e., OSHA, TJC, CMS, HIPAA).

6. Customer Service & Teamwork

   • Provide excellent customer service and promote teamwork with a positive attitude, following our customer service standards.

Population Served

• Neonate

• Pediatric

• Adolescent

• Adult

• Geriatric

Minimum Job Requirements

Education & Experience:

• Required: Ability to read, write, and communicate effectively in English.

• Required: Experience in Medical Billing/Coding or a Medical Billing Coding degree or certification.

• Required: Proficiency in spreadsheet applications (Excel).

• Required: Proficiency in computer systems and ten-key data entry.

Knowledge, Skills, and Abilities:

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