Medical Insurance Processor - 6 - 12 Months Contract (69249)

MEDICAL INSURANCE PROCESSOR

CONTRACT: 6 months (W2); may go up to 1 year; will not convert to permanent

LOCATION: Aurora, CO 80014

JOB NUMBER: 69249

CLIENT: One of the country's largest health care and health plan providers

DEPARTMENT: Patient Financial Services

PAY RATE: $13/hr

PURPOSE OF POSITION:

- Additional support to assist with increased workload for processing insurance verifications
- Process both Insurance Claims and Patient Claims and work with the EPIC system

JOB DESCRIPTION AND ESSENTIAL FUNCTIONS:

- Identify and verify primary and secondary insurance coverage for all new and existing patients and/or determine if the patient has no eligibility or coverage on the date of service
- Responsible for assessing where work flow improvements are necessary and communicate such recommendations to the appropriate supervisor
- Ensure that he/she follows departmental and Regional policies and procedures
- Fills in for absent employees and assists employees with large workloads as needed
- Creates guarantor accounts, adding and removing account coverage
- Work from several spreadsheets/logs and update systems
- Complete multiple work queue assignments (as assigned daily)
- Add workers compensation related claim information to registration
- Identify Coordination of benefits for commercial payors and update account status
- Works closely with other departments to identify insurance coverage and determine eligibility
- Submit Medicaid and Commercial Prior Authorization request for medical treatment and complete follow up work
- Receive inbound calls from members related to billing questions
- Make outbound calls to insurance companies, members and other health care providers for eligibility inquiries
- Identify visiting members, create medical record number and add coverage for all future appointments
- Special Projects may be assigned

REQUIRED EDUCATION, EXPERIENCE, AND SKILLS:

- High School diploma or GED
- Minimum of 3 years of experience with insurance verification with medical benefit coverage
- Patient Claims Processing experience
- Adjudication experience
- Comprehensive knowledge of third party payer requirements
- Working knowledge of commercial insurance primary and secondary payors
- Comprehensive knowledge of applicable insurance laws, and regulations related to Workers' Compensation, No-fault, Coordination of Benefits (COB), Medicare, Medicaid, Tri-care, Champva including CHP+ policies, and Third-Party-Liability (TPL)
- Working knowledge of CPT-4, ICD-9 and medical terminology
- Very strong customer service skills
- Strong attention to detail (take information and enter accurately)
- Strong reporting and computer experience (Word and Excel)
- Detail-oriented with good organizational and critical thinking skills and have the ability to multi-task
- Must be able to work independently without direct supervision

PREFERRED EXPERIENCE, AND SKILLS:

- Insurance Verification background
- Experience working within the Resolute/Epic in a healthcare environment preferred
- Knowledge of eSummit Exempla system
- Work experience in medical billing and collections with working knowledge of HCFA 1500, UB92 forms and other billing forms
- Understanding of the claims system QCare
- Understanding of the electronic insurance verification using passport processes