Insurance Denial/Appeals Clerk

Job Details

Description

Mountain View Hospital is looking for a Insurance Denial / Appeals Clerk to join our team!

JOB SUMMARY :

Responsible for insurance follow up and or appeals for Mountain View Hospital and Idaho Falls Community Hospital. Work denials on a daily basis.

Review account to see if appeal is needed and appeal. Ability to maneuver and work claims in Claim Source.

BENEFITS :

Taking care for our community starts with taking care of our own team. Mountain View Hospital is proud to offer its employees competitive and comprehensive benefit packages. Benefits include :

• Medical, Dental and Vision Insurance
• Paid Time Off (vacation, holidays and sick days) and Medical Paid Time Off
• Retirement Plans (401K with up to 6% match)
• Earned Quarterly Bonus Program
• Education Reimbursement Program
• Discount for medically necessary procedures performed at Mountain View Hospital and Idaho Falls Community Hospital

Please note benefits are based on eligibility according to full-time, part-time or PRN status classification.

DUTIES AND RESPONSIBILITIES :

• Responsible for the timely follow-up and collections of all billed Commercial insurance accounts by running appropriate reports, utilizing online tools, and making contact with payers over the phone or online.
• Updates the patient account record to reflect the current actions that had been taken.
• Reviews EOB’s / payments and verifies that accounts are being paid according to contract.
• Sorts / files correspondence and maintains items in date order. Responsible to work and follow-up on reminders daily.
• Processes non-clinical appeals on accounts when appropriate. Sends requests to medical records as needed.
• Responsible for rebilling claims when required. Responsible for contacting responsible party if additional information is requested for billing purposes.

Responsible for notifying insured of insurance denials.

• Processes denials from insurance EOB’s weekly.
• Identifies problem accounts as well as claims processing delays and escalates to management.
• Maintains various payers bulletins and educational updates in work area. Attends / participates in all available educational opportunities to stay in compliance with insurance and government regulations.
• Maintains patient confidentiality at all times
• Responsible for knowing hospital policies and being familiar with hospital services
• Performs other job related duties as assigned by management.
• The employee is required to comply with all PCI standards and other company policies and procedures for payment card acceptance and security.

ABOUT MOUNTAIN VIEW :

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients.

We serve the entire Snake River Valley all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice.

Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day.

If you are looking for a career where you can make a difference in your community, we invite you to apply.

Qualifications

Education / Certification : High school diploma or general education degree (GED).

Experience : Minimum two years office experience or current employment in a related field preferred. Familiar with billing forms UB04 and HCFA 1500 preferred.

Equipment / Technology : Ability to use hospital information system, and operate basic computer functions and software.

Language / Communication : Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.

Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.

Mathematical Skills : Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals.

Ability to compute rate, ratio, and percentages and to draw and interpret bar graphs.

Mental Capabilities : Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form.

Ability to deal with problems involving several concrete variables in standardized situations.

Interpersonal : Ability to work well with others.