Claims Specialist at Gila River Health Care Sacaton, AZ 85147
Ensures timely collection of nearly all outstanding accounts receivable from insurers by performing the following duties personally.
Responsible for ensuring that all critical tasks are fulfilled on a timely basis.
Maintains and continually updates knowledge of insurance and government reimbursement policies and procedures while understanding causes of their payables delays and oversights.
Coordinates and collaborates with patient registration, coding and billing team members to resolve payment denials properly in all cases where internal enterprise errors contribute to funds owed.
Submits adjustment requests to management for approval when appropriate based upon underlying facts.
Notified management of all observed enterprise methodologies that may be contributing to receivables issues so that appropriate internal systemic corrections may be implemented.
Submits corrected claims or appeals when underlying facts indicate the necessity for such actions.
Maintains a successfully appropriate collections methodology with proper fact-based and sufficiently aggressive methodologies to reduce payment delays and payor errors.
Communicates with payors in pursuit of full payment on all accounts receivable via telephone and electronic means.
Develops, maintains and continually updates knowledge of and ability to efficiently use electronic payor interfaces and databases.
Takes all steps necessary to avoid write-offs.
Processes refund requests on a timely basis when properly requested by payors presenting underlying facts substantiating prior overpayments.
Accurately performs data input related to all receivables' actions taken.
Manages all receivable's data on an accurate and ethical basis without loss of data.
Completes appropriate adjustments in the receivables system within authority to do so.
Receives necessary approval from management to do so when necessary.
Prepares analyses of receivable's accounts as required.
Complies with all regulatory requirements regarding patient/resident personal information.
Assists in monthly closings.
Notifies all necessary executives regarding any problematic payors, and takes all actions as directed.
Assists with other accounts receivable and/or billing subjects and activities as necessary.
Demonstrates ability to regularly change priorities to accomplish all tasks despite frequent interruptions.
Demonstrates ability to clearly communicate, both orally and in writing, while performing all essential functions.
Performs other special projects and duties as assigned.
High School diploma or GED.
1 to 4 years of accounts receivable and/or collections experience, preferably within a health care environment.
Recent successful experience with collections made from insurers, federal government and/or state government payors having occasionally long payables cycles.
Demonstrated ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures.
Interest in medical subjects, patient services/care, and customer service.
Prior medical environment work experience is preferred.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
Responsible for ensuring that all critical tasks are fulfilled on a timely basis.
Maintains and continually updates knowledge of insurance and government reimbursement policies and procedures while understanding causes of their payables delays and oversights.
Coordinates and collaborates with patient registration, coding and billing team members to resolve payment denials properly in all cases where internal enterprise errors contribute to funds owed.
Submits adjustment requests to management for approval when appropriate based upon underlying facts.
Notified management of all observed enterprise methodologies that may be contributing to receivables issues so that appropriate internal systemic corrections may be implemented.
Submits corrected claims or appeals when underlying facts indicate the necessity for such actions.
Maintains a successfully appropriate collections methodology with proper fact-based and sufficiently aggressive methodologies to reduce payment delays and payor errors.
Communicates with payors in pursuit of full payment on all accounts receivable via telephone and electronic means.
Develops, maintains and continually updates knowledge of and ability to efficiently use electronic payor interfaces and databases.
Takes all steps necessary to avoid write-offs.
Processes refund requests on a timely basis when properly requested by payors presenting underlying facts substantiating prior overpayments.
Accurately performs data input related to all receivables' actions taken.
Manages all receivable's data on an accurate and ethical basis without loss of data.
Completes appropriate adjustments in the receivables system within authority to do so.
Receives necessary approval from management to do so when necessary.
Prepares analyses of receivable's accounts as required.
Complies with all regulatory requirements regarding patient/resident personal information.
Assists in monthly closings.
Notifies all necessary executives regarding any problematic payors, and takes all actions as directed.
Assists with other accounts receivable and/or billing subjects and activities as necessary.
Demonstrates ability to regularly change priorities to accomplish all tasks despite frequent interruptions.
Demonstrates ability to clearly communicate, both orally and in writing, while performing all essential functions.
Performs other special projects and duties as assigned.
High School diploma or GED.
1 to 4 years of accounts receivable and/or collections experience, preferably within a health care environment.
Recent successful experience with collections made from insurers, federal government and/or state government payors having occasionally long payables cycles.
Demonstrated ability to relate to diverse cultures and specifically the Gila River Community and/or other Native American cultures.
Interest in medical subjects, patient services/care, and customer service.
Prior medical environment work experience is preferred.
.
Estimated Salary: $20 to $28 per hour based on qualifications.
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