Insurance Claims Processor

United Regional Health Care System - Wichita Falls, TX

Full-time

Wichita Falls, TX

Hospitals

About the position

The Insurance Claims Processor is responsible for filing insurance claims for hospital and physician services using UB-04 and HCFA 1505 forms. This role involves computing insurance benefits, allowances, adjustments, and patient balances, as well as processing tracers and verifying reimbursements from various payers. The position requires effective communication with patients, insurance companies, and other hospital departments to ensure positive customer relations and accurate claims processing.

Responsibilities

• Files insurance claims on the UB-04 and HCFA 1505 forms for hospital and physician services.
• Computes insurance benefits, allowances, adjustments, and patient balances.
• Processes tracers and verifies reimbursement from payers.
• Displays positive customer relations with other departments, patients, and insurance companies.
• Compiles data and prepares insurance claims for billing.
• Reviews and corrects/posts appropriate adjustments to patient accounts.
• Investigates and corrects questionable charges to patient accounts.
• Reviews assigned insurance reimbursement and ensures correct account balance.
• Generates appropriate secondary billing if applicable.
• Ensures claims are filed accurately on a daily basis utilizing billing processes.
• Processes tracers for hospital and physician claims ensuring timely filing.
• Verifies and calculates hospital and physician payments, follows up on incorrect payments or denials.
• Notifies management of any consistent discrepancies or potential reimbursement problems.
• Processes daily reports, mail, e-mails, and phone calls.
• Determines whether to re-file a claim, refund, or process an adjustment.
• Identifies Medicare and Medicaid combine messages on a daily basis.
• Processes email requests from other departments in a timely manner.
• Works on non-billable reports ensuring adjustments are posted accurately and timely.
• Ensures all mail received is worked within 2 days of receipt.

Requirements

• High school graduate or equivalent.
• Over 1 year and up to 2 years experience in insurance claims processing or related job experience.
• Ability to communicate effectively in English, both verbally and in writing.
• Knowledge in all areas of insurance, including billing data analysis on UB-04 and HCFA 1505 forms.
• Knowledge of filing practices for all third party payers.
• Ability to compute insurance benefits, allowances, adjustments, and patient balances.
• Knowledge of the appeal process to government payers and other payers as assigned.
• Ability to analyze payment practices of governmental payers and other payers as assigned.
• Knowledge of patient accounts and ability to discuss account information with patients and insurance companies.
• Ability to read, comprehend, and apply governmental rules and regulations.
• Ability to utilize tools available (e.g., payer websites).