BUSINESS OFFICE - CONTRACT MANAGEMENT CLERK

Job Summary

Responsible for insurance follow up and or appeals and contract management for Mountain View Hospital and Idaho Falls Community Hospital and Snake River Hospitalists. Ensures claims are paid according to hospital contracts with payors, and will appeal claim if/when necessary to have them reprocessed and paid accordingly.

Duties And Responsibilities

• Responsible for the timely follow-up and collections of all billed Commercial insurance accounts by running appropriate reports, utilizing online tools, and making contact with payers over the phone or online.
• Must be familiar with legal jargon and contract wording and have the ability to apply that language to hospital encounters.
• Attention to detail and organization a must.
• Updates the patient account record to reflect the current actions that had been taken.
• Reviews EOB’s/payments and verifies that accounts are being paid according to contract.
• Sorts/files correspondence and maintains items in date order.
• Processes non-clinical appeals on accounts when appropriate. Sends requests to medical records as needed.
• Processes rebilling claims when required.
• Responsible for contacting responsible party if additional information is requested for billing purposes.
• Notifies insured of insurance denials.
• Processes denials from insurance EOB’s weekly.
• Identifies problem accounts as well as claims processing delays and escalates to management.

About Mountain View

Mountain View Hospital and our 29 affiliate clinics are committed to providing compassionate, cutting edge care to our patients. We serve the entire Snake River Valley – all the way from Pocatello to Rexburg. Our medical capabilities span everything from wound care to urgent care, oncology to neurology, physical therapy to speech therapy, a Level III NICU, robust robotic surgery department and a continuously expanding rural health practice. Our work environment is mission driven, people-centric and supportive. It is what sets apart and makes people excited to come to work each day.

Qualifications

• Education/Certification: High school diploma or general education degree (GED).
• CPC Certification is beneficial.
• Experience: Minimum four years office experience or current employment in a related field preferred. Familiar with billing forms UB04 and HCFA 1500 preferred.
• Equipment/Technology: Ability to use hospital information system, and operate basic computer functions and software.
• Language/Communication: Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of the organization.
• Mental Capabilities: Ability to apply common sense to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations.