Government Claims Representative
- Employer
- HealthEast Care System
- Location
- Saint Paul, Minnesota
- Salary
- Not Specified
- Posted
- Feb 20, 2017
- Closes
- Mar 26, 2017
- Ref
- 2629411029#GIJ--J2CBackfill.2
- Category
- Claims
- Job Type
- Not Specified
- Career Level
- Not Specified
Overview:Provide daily management of claims processing and submission of Government claims for homecare. Performs regular and consistent follow up, denial management, correction and/or reprocessing of claims as necessary. Excellent understanding of multiple products such as PMAPs and Medicare Advantage plans. Responsibilities:Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission including knowledge of the grievance and/or reconsideration process Ability to handle complex claim submission and follow up For example: benefits exhausted, Part B only, AB rebills, Outlier claims, Consolidated Funding, and three day rule Good understanding of benefit contracts, policies, government regulations, coordination of benefits, and healthcare terminology Manages quarterly Medicare credit balance report and resolves open credit balances Utilizes all resources available, including electronic inquiries to verify eligibility, benefits, and claim status Resolves Return to Provider (RTP) claims using Direct Date Entry (DDE) Enters Hospice Notice of Election (NOE) claims via DDE Exercises good judgement towards account resolution and documents all activity on account in clear, accurate, and consistent manner Researches problem accounts and take necessary action and/or make recommendations to ensure timely resolution of account balances and resolve credit balance accounts Contact patient for additional information in order to have claims processed and paid in a timely manner Perform due diligence to contact patient by phone and/or send a letter Advise manager/coordinator of any billing errors, payer trends, denials, or payment fluctuations, to ensure proper handling and escalation when necessary Meet departmental productivity and quality assurance standards in accordance with departmental policies Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards Actively participates in creating and implementing improvements Performs other responsibilities as needed/assigned Qualifications:High school graduate or equivalentMinimum 2 years office experience Experience in a healthcare setting preferred Knowledge: Government billing requirements CPT and ICD10 coding UB04 and CMS1500 claim forms Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task Computer Skills Basic: Ability to use a computer and applications that are associated with performing basic work tasks (navigate in Windows, Outlook, etc) Data Entry: Skilled in entering data and calculating items for processing; input of data into computer systems Math Basic Skills: Knowledge and skills related to applying mathematical tools and methods for routine calculations Medical Terminology/Spelling: Familiar with medical terminology and medical spelling Organization: Effective management of projects, deadlines, and work load prioritizing Putting things together in an orderly and functional whole Problem Solving: Identifies problems Determines accuracy and relevance of information Utilizes appropriate tools and staff resources along with sound judgment to generate and evaluate alternatives, and to make recommendations About HealthEast At HealthEast, our patients are our neighbors and we are dedicated to their, and our, optimal health and well-being. We are guided by our faith-based heritage, a call to healing that respects the dignity and culture of every person. We empower our patients with user-friendly access to their health information, dependable service, and affordable, high-quality care. We put new, more efficient models of care into practice, allowing our 7,500 employees and 850 physicians to focus on what s important: providing compassionate health care that puts the patient and their needs first. With 14 clinics, home care, a medical transportation center, and four hospitals Bethesda Hospital, St. John s Hospital, St. Joseph s Hospital, and Woodwinds Health Campus we provide excellent family health and specialization, including primary, maternity, orthopaedics and post-acute care.
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