Required Education and Experience : High School graduate or equivalent required. Insurance Experience required.
Preferred Education and Experience : Two years’ experience in a related field preferred.
Additional Eligibility Qualifications : Accurate typing rate of 40 wpm and data entry skills required. Aptitude to retain detailed information.
Must possess the ability to work within general and plan guidelines. Ability to prioritize and be able to produce an acceptable volume of work.
Possesses good problem-solving skills. Have mathematical aptitude and an ability to concentrate on details is necessary.
Excellent organizational skills. Ability to assess a situation and decide best course of action. Excellent communication skills, oral and written.
Be able to communicate ideas in a clear and concise manner. Use inter-personal skills effectively to communicate with internal and external customers to resolve payment issues.
Basic knowledge of Windows based computer applications. Be able to operate the following equipment : computer, copier, fax and 10-key calculator.
Professional appearance and manner.
Summary / Objective : The Senior Insurance Payment Processor will mentor and aid in the training of Payment Processors for all payers, to meet and maintain department goals.
They will assist in processing payments, monitoring work queues and reconciling payments; ensuring payments are posted into the patient’s account with the correct amount and adjustment.
Essential Functions
Provide expert knowledge and ability to post payments for all carriers
Mentor and provide training / refresher training to payment processors.
Assist with maintaining department training material.
Provide back-up coverage for open positions or absent processors.
Review EOBs closely to ensure that all items are being posted accurately (i.e., correct date of service, correct allowable, non-covered items, patient responsibility).
Verifies that payment is correct according to our individual contract with specific carriers, and correct contractual adjustments are done only against contracted carriers.
Reconcile deposits and EOBs for assigned carriers and provide an accurate accounting of unposted totals and carrier issues to leadership.
Does appropriate follow-up on the unidentified account or work queues as assigned.
Posts insurance payments / rejections to the account receivable in the system in a timely manner. The acceptable standard of production is no less than 8,000 transactions per month.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
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