Physician Insurance Analyst 3

About the role

The Physician Insurance Analyst 3 performs the duties of a Physician Insurance Analyst 1 and 2 while taking ownership for the timely and accurate editing, submission, and/or follow-up of assigned claims in order to meet expected productivity and quality standards on a weekly basis. Processes claims for all payer types (e.g., Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.). Ensures that all assigned claims meet clearinghouse and/or payer processing criteria. Processes payer response/rejection reports timely while meeting departmental productivity and quality review standards, all while identifying and reporting trends and assisting in the development and deployment of training relative to trends.

Responsibilities

• Ensures that all clean claims are submitted the day they are received, via the appropriate medium and with all required attachments.
• Provides resolution for pending claims within allowable timeframes, as defined for appropriate deficiency, and/or provides appropriate account follow-up based on established System Response Guidelines and Matrix.
• Resolves basic issues either through individual actions or by seeking assistance and direction from management.
• Meets productivity and quality expectations weekly for assigned work lists and any supervisor-assigned special tasks.
• Correctly completes write-off requests and submits them daily for supervisor review.
• Documents and reports claims submission issues immediately and provides feedback to management.
• Ensures that payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards.
• Identifies issues with payer rejections and provides feedback regarding rejections to management.
• Maintains knowledge of payer requirements, 1500 standards, and system (e.g., vendor, clearinghouse, payer) functionality and policies/procedures.
• Ensures appropriate and timely documentation of all account activity while appropriately handling all correspondence.
• Completes all assigned Epic billing/claim edits and ensures all required reports are filed timely and accurately.
• Ensures documentation is professional, appropriate, accurately depicts actions performed, and is in accordance with departmental quality review standards.
• Ensures that all daily, weekly, and monthly reports are completed, submitted timely, and with minimal errors.
• Works all assigned Epic billing and claim edits, and/or follow-up needs, daily.
• Identifies opportunities for Revenue Cycle performance improvement based on regulatory, payer, physician, departmental, and/or multiple specialty service line analysis (e.g., Neurology, Cardiology, Oncology, Behavioral Health, Neurosurgery, Orthopedic, and General Surgery).
• As needed, travels to Inova sites/offices to print claims and attachments for submission to insurance payers.
• Demonstrates ability to effectively use and navigate all payer portals.
• Attends and actively participates in team meetings and huddles.
• Works on special projects related to claims and denials follow-up, and may perform other additional duties as assigned.

Minimum Qualifications

• Experience: Two years of experience in Revenue Cycle operations, billing, collections, cash posting and/or administrative support in physician billing
• Education: High School or GED

Benefits

• Medical, dental and vision coverage
• Robust team member wellness program
• Inova matches the first 5% of eligible retirement contributions starting on the first day
• Tuition and student loan assistance: up to $5,250 per year in education assistance and up to $10,000 for student loans
• Mental health support: up to 25 mental health coaching or therapy sessions per person per year at no cost for team members, their spouses/partners, and their children
• Paid time off and paid parental leave