Insurance Analyst - Insurance Department

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918322

Vidant Health

Full Time

Regular

Summary

About Vidant Health

Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.

Responsibilities

  • Process claims utilizing billing software containing payer specific edits. Review and resolves errors based on payer regulation and departmental policies including charge reconciliation prior to claim submission. For secondary & tertiary claims, populate applicable fields with the appropriate payment, coinsurance, deductible and reason codes. Submit valid  claims daily to the third party payers. Documents all actions taken.
  • Receives daily confirmation reports from post-electronic transmission. Evaluates error reasons, correcting and revalidating claims for resubmission. Makes revisions to mainframe and billing systems and assigns the proper denial reason code for tracking. Documents all actions taken.
  • Review rejections and denials with appropriate actions being taken to correct or appeal. Updates all systems. Documents all actions taken.
  • Pursues collection on accounts not paid in greater than 25 days. Communicates with third party payers and patients in order to expedite payment or account resolution. Documents all actions taken.
  • Review managed care data for over and underpayments. Verifies discrepancy by evaluating and confirming data posted and contract terms. Submit appropriate documentation to support reconsideration of the claim.
  • Facilitate payment arrangements with non-contracted payers. Determines appropriate reimbursement methodology based on hospital service and term of payment.
  • Reviews payer bulletins and websites for changes in rules and regulations. Interprets and incorporates changes into billing and collection activities. Attends educational seminars and meetings.
  • Responds to all requests for documents required for timely claims adjudication and prompt patient customer service.
  • Performs in accordance with accepted procedure and responds to special requests by management in a timely and accurate manner.
  • Adheres to the policies and procedures. Uses tact and courtesy in all interactions including but not limited to staff, patients and payers. Promotes a positive image and supports management in goals and objectives. Handles inquiries and complaints discreetly and effectively.

Minimum Requirements

  • High School plus 2 years or more of formal training or education in Health Occupations, Business or related or Associate College Degree.
  • Windows based PC skills.
  • More than 2 years but less than 3 years in Hospital or physician office billing experience. Third party experience. Patient Accounting or Cash Applications experience.
  • One year of related experience may be substituted for one year of education up to two years.
  • A four year degree in a health related field may substitute for one year of the required experience.

Other Information

  • 1 full time vacancy, days

 

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

 

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