Claims Processor
GREAT PLAINS HEALTH
NORTH PLATTE, NE
Full-time
Health Care Provider
Posted on November 10, 2019
Home Health Services
Full Time
Day Shift
- Mission
- To inspire health and healing by putting patients first - ALWAYS.
- Position Summary
- The Claims Processor is responsible for the timely filing of all insurance claims, including electronic claims filing, secondary filing and paper filing.
- Minimum Qualifications
- Education
- High school diploma or equivalent is required.
- Credentials
- None
- Education
- Physical Demands
- Sit constantly.
- Stand/walk frequently.
- Lift floor to waist height 30 pounds occasionally; waist to waist 25 pounds occasionally; waist to overhead 20 pounds occasionally. And carry 10 pounds up to 25 feet occasionally.
- Reach overhead frequently standing and turn reaching shoulder height while sitting frequently.
- Fine motor coordination within normal limits for age and gender.
- Constant computer use.
- Visual acuity within normal limits.
- Essential Functions
- PROCESS CHARGES FOR VISITS, SUPPLIES,AND OTHER ITEMS - Accurately enters patient billing data, including visit charges and supply charges, into the information system.
- REGULATIONS & GUIDELINES - Demonstrates knowledge and understanding of Home Health/Hospice revenue cycle components including regulations and billing guidelines.
- HOSPICE PHARMACY CHARGES Reconciliation and transcription of Hospice Pharmacy charges, including scanning and tracking Proof of Delivery Forms. Collaborates with Great Plains Health Pharmacy to update/maintain Hospice medication chargemaster.
- PRIOR AUTHORIZATION – Obtains all ongoing authorizations per payer requirements for all Home Health or Hospice services.
- CODING - Ensures appropriate ICD-10 coding and sequencing as it relates to the patient’s medical condition, including any co-morbidities.
- PRE-BILLING AUDITS - Performs non-clinical QA audit on each chart (visit verification, documentation requirements) especially as related to billing compliance.
- CLAIMS SUBMISSION – Generation and transmission of electronic payer claims. Printing and mailing of paper claims where necessary.
- NURSING HOME BILLING – collaborates with local nursing facilities on submission, collection, and payment of Medicaid room/board charges.
- Demonstrates knowledge and understanding of Home Health/Hospice software application and office equipment and provides support for these as necessary.