Insurance Analyst at Careers Integrated Resources Inc

Job title : Insurance Analyst

Location: Rancho Mirage, CA

Duration: 3+ Months (Possible Extension)

Shift: Mon-Fri 8 am - 5 pm

Monday thru Friday Schedules will be either 7:00- 3:30 7:30 – 4:00 or 8:00 – 4:30

Pay range: $20 - $21/hr. on W2

Description:

· Demonstrates compliance with Code of Conduct and compliance policies and takes action to resolve compliance questions or concerns and report suspected violations.

· Manages new accounts, on a daily basis, by working within Receivables Workstation. Interfaces with other departments within the hospital, when appropriate, to obtain information necessary to process or resolve claims. Contacts patient and/or account guarantor to solicit payment on account.

· Works all accounts listed in the Follow-Up queue, on a daily basis to promote collection of accounts. This will include telephoning the payer, messaging, or identifying the claim on the payers’ Internet websites.

· Manages account inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.

· Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.

· Processes incoming correspondence, including signature letters, denials, prior authorizations, and additional information necessary to process the claim.

· Records newly identified insurance plans and facilitates the account processing of new plan in accordance with pre-billing policies and procedures.

· Records accurate and definitive notes in the electronic account file that depict the status of account, issues with account and anticipated date of resolution.

· Escalates account management to Supervisor when issues arise, if needed.

· Ensures PFS management is kept up to date with contract, payer or system changes and/or issues.

· Assigns a status code to each worked account to enable account tracking, statistical data gathering and audit activities.

· Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance.

· Handles special projects as directed by management e.g. high dollar accounts, accounts over 180 days old, etc.

· Maintains productivity standards by payer assignment.

· Reviews denial, payor rejection, and any other necessary reports to determine strategy in decreasing payor denials, clearing house rejections and delayed payments

· Manages Commercial Insurance, Medicare credits and Medicare quarterly credit balance reports to ensure timely resolution of refunds and balance rectification.

· Manages priority account inventory in a timely manner to promote payment and resolution of all accounts as instructed by management.

· Regularly analyses account inventory aged greater than 90 days to promote payment and resolution of all accounts to decrease AR days.

· Provides analysis on aged inventory for future checks and balances and timely resolution to PFS Management Staff and Director.

· Processes incoming hard copy explanation of benefits and reacts appropriately to resolve the accounts.

· Obtains and records “Promise to Pay” amounts daily that are consistent with the cash collection goals.

· Identifies work unit issues and participates in solutions and problem solving by working with supervisor and staff members.

· Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.

· Participates in Payer webinar and training sessions to maintain latest knowledge on billing, coding and reimbursement practices, monitors updates with Insurance Payers and relays information to management, trainers and co-workers effectively.

· Performs other job-related tasks as assigned.