At UHS, we're looking for exceptional people who share our vision and values, who share our focus on hard work, enthusiasm, teamwork, loyalty, trust and cooperation. We've embraced these traits and built a team of employees who consistently work to achieve the highest level of service excellence. People are our most valuable resource at UHS as we are committed to providing high quality acute care and behavioral health services to residents of the communities we serve. We are equally committed to offering our employees unlimited opportunity in an environment that encourages professional development.
The Claims Specialist is responsible for the accurate and timely resolution of professional billing claim and clearinghouse edits as well as payer rejections. This includes registration-based edits, claim requirement data edits (e.g. missing admission date), provider enrollment edits (e.g. missing NPI) and payer-specific edits. Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor. Performs root cause analysis and identifies edit trends timely to minimize lag days, mitigate large volume claim submission delays and maximize opportunities to improve process and update the Practice Management System (PMS) logic as needed. Exercises good judgement in escalating identified root causes and edit trends to the Billing Supervisor, as needed, to ensure timely resolution and communication to stakeholders. Demonstrates the ability to be an effective team player. Upholds "best practices" in day to day processes and work flow standardization to drive maximum efficiencies across the team. Communicates effectively with IPM Coders to handle accurate and timely resolution of coding-based claim edits.
Essential job duties include:
Accurately reviews and resolves assigned claim and clearinghouse edits and payer rejections to minimize lag days. Meets or exceeds established performance targets (productivity and quality) established by the Billing Supervisor.
Provides prompt attention to edit trends and identified root causes with timely resolution and escalation to the Billing Supervisor as needed.
Utilizes real time eligibility verification checks accordingly to accurately update patient registration in the Practice Management System (PMS) for registration-based edits. Captures registrations error trends and eligibility tool response issues and reports promptly to the Billing Supervisor.
Initiates support calls to the clearinghouse Help Desk as needed to gain clarification on clearinghouse edits. Communicates clearinghouse edits that are a road block to claim submission, to the Billing Supervisor, so clearinghouse edit/s can be updated as needed.
Partners with IPM Coders to achieve timely resolution of coding-based claim and clearinghouse edits and payer rejections.
Effectively prioritizes work assignment/s and demonstrates flexibility in assuming edits assigned to other Claims Specialists to minimize lag days and ensure team goals/objectives are met.
Participates in regularly scheduled team meetings offering new paths, procedures and approaches to edit resolution to maximize opportunities for performance and process improvement.