Insurance Claim Analyst/Refund Coordinator

Consulting Radiologists, Ltd. is seeking an Insurance Claim Analyst/Refund Coordinator. In this hybrid position, the main responsibilities would include maintaining accounts receivable at Insurance Department standards; monitor reimbursement from payers to ensure accurate payment levels; and responsibility for researching and reviewing patient account credit balances for accurate refunds by comparing the balances to the Explanation of Benefits (EOB) statement for potential refunds back to the patient and/or insurance company.

Insurance Claims Analyst Responsibilities:

  • Maintain accounts receivable of greater than 120 days at 7% or below.
  • Process insurance correspondence on a daily basis.
  • Perform necessary follow-up to resolve unpaid/rejected claims.
  • Submit appeals on denied claims when appropriate.
  • Monitor accounts receivable age.
  • Examine insurance claims and EOB’s for accuracy.
  • Research and correct rejected claims with clearing house.
  • Serve as liaison between CRL and assigned insurance company(ies).
  • Additional responsibilities as assigned by management.

Refunds Coordinator Responsibilities:

  • Reviews and troubleshoots patient account credit balance to ensure accuracy of refund.
  • Print appropriate documentation such as EOB’s for credit balance accounts.
  • Accumulate, process and print refund checks.
  • Additional responsibilities as assigned by management.

Qualifications:

  • Post high school education preferred.
  • Minimum one year experience in provider billing processing.
  • Six months or more experience in credit/debit account principles.
  • Six months or more experience in payment entry and A/R.
  • Previous experience with healthcare insurance preferred.
  • Experience with and general knowledge of industry standard forms and files, such as: CMS 1500, EOB’s, EDI 835’s and 837’s, etc.
  • Basic CPT and ICD10 coding knowledge and familiarity with medical terminology.
  • Experience using EPIC and using Healthia (or other eligibility verification tools), preferred
  • Demonstrated ability to work well in a team-oriented environment.
  • Excellent communication and organizational skills, detail-oriented, and ability to learn quickly.
  • Able to perform intermediate math.
  • Must be flexible in accepting and carrying out work assignments.
  • Typing skills of 40 wpm accurately.
  • Ability to communicate in English effectively through written and verbal communications.

Physical Demands:

  • Sedentary
  • Frequent computer/keyboard usage
  • Lifting weight up to 10 pounds occasionally

Schedule: Monday-Friday