Electronic Insurance Claims Specialist (Remote Options Available)

• Prepare and submit HIPAA compliant claims to 3rd party payors through data exchange programs or as indicated by payor; review claims and account documentation to ensure accurate billing and utilize billing edit reports to correct and revise claims to ensure claim accuracy and prompt billing.

• Resolve billing edit errors generated via in-house scrubber reports and claim checks as well as through individual payor editing programs; resubmit claims where appropriate.

• Continually interact with various departments to resolve billing edit errors ensuring correct claims submission in an automated billing environment.

• Maintain job knowledge to effectively carry out the responsibilities of assigned insurance (s) group including CPT, HCPC, ICD-9 coding, occurrence, condition, span and value codes in addition to modifiers.

• Add and remove charge procedure codes, modifiers, and other codes as directed by clinical department heads.

• Maintain supporting documentation for all account changes with originating department sign-off.

• Pursue other insurance information through eligibility verification and check claims status through online access, including WEBMD, NEHEN, REV's, FISS, and individual insurance carriers websites.

• Resolve unbilled accounts through downloaded claim rejection reports, insurance internet websites, and other reports and/or claim listings where appropriate.

• Investigate and resolve non-routine billing problems with third party payors and federal/state agencies.

• Perform individual claim entry, adjustments, and cancels, through online access to specific payors websites.

• Respond to insurer inquiries in a professional, timely, efficient and knowledgeable fashion, ensuring HIPAA guidelines are followed.

• Maintain knowledge of Microsoft Excel, Word and Outlook to create and maintain logs and reports as needed to support Patient Financial Services activities.

• Performs related clerical activities such as typing, photocopying, filing, calculating, faxing, mail sorting and distribution, etc. as necessary.

• Contributes as a team member in support of the hospital and departmental work activities and projects.

• Assists the department, work unit and/or fellow staff members by covering for absences, training activities, etc.

• Complies with departmental and organizational policies including but not limited to, dress code, use of supplies, telephones and computers.

• Adheres to work schedules and maintains a safe and orderly work area at all times, maintaining awareness of and compliance with safety policies and procedures.

• Attends and participates in educational programs, in-service meetings, workshops, and other activities as related to job knowledge and state guidelines.

• Clearinghouse experience and ability to analyze automated computer output.

• Performs other job related duties and assignments as requested.

Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers in a manner that reflects Cape Cod Hospital's commitment to CARES: compassion, accountability, respect, excellence and service.

• Ability to read, write and communicate in English.
• High School diploma or GED required.
• PC skills, including Microsoft Excel, Word and Outlook, with a minimum of 6 months experience working with an EMR or financial information system on a daily basis within the past three (3) years.
• Experience in a healthcare setting preferred.