The Physician Insurance Analyst 4 completes all assigned EPIC billing/claim edits and ensures all required reports are filed timely and accurately. Identifies opportunities for revenue cycle performance improvements and reports to the management team as it relates to assigned duties. Actively identifies and reports trends, and assists in the development and deployment of training relative to trends in conjunction with the Team Leads, Supervisors, Managers, and/or Directors.
Job Responsibilities
- Performs the duties of a Physician Insurance Analyst 1, 2, and 3 and demonstrates leadership by providing training to new staff or deploying insurance updates to existing staff.
- Responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims, while meeting the expected Productivity and Quality Standards on a weekly basis.
- Processes claims for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) and processes all types of EPIC charge reviews and claim edits. Assure all assigned claims meet clearinghouse and/or payer processing criteria.
- Processes Appeals (levels 1 and 2) and checks claim status via phone/payer website for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.).
- Identifies trends and analyzes data, escalating trends to the appropriate leader/teams.
- Ensures payer response reports and rejection/denials reports are worked timely and meet Departmental Productivity and Quality Review Standards.
- Effectively interprets CPT, ICD-10, and APC reimbursements to ensure a strong receivable performance.
- Assures appropriate and timely documentation of all account activity.
- Ensures correspondence is handled appropriately.
- Attends, actively participates in, and, at times, leads team meetings and huddles.
- Assists in department report out emails/monthly metrics reporting.
- As needed, travels to Inova sites/offices to print claims and attachments for submission to insurance payers.
- Demonstrates a strong understanding of SRG.
- Demonstrates ability to effectively use and navigate all payer portals, and effectively trains new team members on all payer portals.
- Works on special projects related to claims and denials follow-up. Leads special projects related to claims and denials follow-up, and may perform other additional duties as assigned.
Additional Requirements
Certification - Not required Licensure - Not required Experience - 3 years Account Executive Experience in Revenue cycle operations, billing, collections, cash posting, and/or administrative support in physician billingEducation - High School or GED
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Inova Health System
Nov 24, 2024