Claims Editor - St. Josephs Candler

• Position Summary
  • The Claims Editor is responsible to ensure all insurance claim edits and or rejections from Meditech and SSI are reviewed, analyzed and resolved. Ensure that the claims are compliant with federal and state regulations. Responsibilities include but are not limited to billing, prompt adding and follow-up of SSI tickets to enhance billing efficencies.Understands the laws that govern the billing.
• Education
  • High School Diploma - Preferred
• Experience
  • 2-3 Years Healthcare claims and Reimbursement - Required
• License & Certification
  • None Required
• Core Job Functions
  • Performs claims editing to ensure a positive cash flow. Accurately screens and processes assigned claims edits and rejections. Meets departmental time standards for corrections. Rebills claims when appropriate.
  • Provides oversight of claims editing. Reviews and analyzes claims editing reports. Determines the source of errors and rejections. Recommends process changes within Patient Accounts and other departments to ensure efficiency and compliance.
  • Creates SSR inquiries to SSI for creation of edits for more efficient workflow.
  • Works collaboratively with others to achieve efficiency and accuracy. Seeks answers/assistance from the appropriate source. Keeps up to date on billing/compliance rule changes

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