Claims Processor

Description

Position Overview: Responsible for ensuring Open Systems Healthcare's compliance with all aspects and levels of Federal, State and local laws, regulations and standards. Collects both Private and Medicaid reimbursements by gathering and transmitting patient care information; resolving discrepancies; adjusting patient bills; preparing reports.

Essential Job Functions:

  • Prepares, maintains, develops and updates essential billing records.
  • Assists in preparation of reports required by regulatory agencies as directed by the Medical Billing Supervisor.
  • Create invoices, handles weekly and monthly billing and monitors collections.
  • Gathers both private and Medicaid billing information by reviewing consumer records.
  • Bills private pay consumers and Medicaid carrier by inputting billing information to database; initiating electronic transmissions.
  • Resolves disputed claims by gathering, verifying, and providing additional information; following-up on claims.
  • Resolves discrepancies by examining and evaluating data; identifying corrective steps.
  • Examine, process, calculate and pay claims insuring filings, documentation and reports, etc.
  • Enter codes and verify data for computer processing.
  • Prepare invoices.
  • Performs all other duties as required and assigned by Administrator and/or Supervisor.
  • Follows Open Systems Healthcare's Policies and Procedures.

Requirements

Required Education and Experience:
  • High School Diploma or GED equivalency, preferred.
  • 2+ years' experience in medical billing, payroll, data entry, or other similar field, preferred.
  • Experience with Microsoft Office, QuickBooks, HCSIS, and PROMISe billing system preferred.

Preferred Competencies:
  • Supportive of OSH's Core Values and of team concept.
  • Able to work in a fast paced work environment.
  • Focus on Customer Needs: Anticipate, understand, and respond appropriately to the needs of internal and external customers to meet or exceed their expectations within the organizational parameters.
  • Ability to handle confidential information in compliance with HIPAA.
  • Ability to effectively communicate externally as well as internally with all levels of the organization.


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