Insurance Clerk Position Available In Calhoun, Alabama

Insurance Clerk Anniston Medical Clinic, PC 1010 Christine Avenue, Anniston, AL 36207 ## Overview We are seeking a detail-oriented Insurance Clerk to join our team. The ideal candidate will be responsible for providing administrative support in an insurance office setting. ## Responsibilities

• Reviews notices of unpaid items to identify rejection codes and reasons for non-payment. Documents in the patient’s account comments items rejected, dates of service, carrier name and the reasons for rejections. Upon verification of non-coverage, gives notices of non-covered services to the Payment Entry Clerk to enter and release from insurance suspense.
• Reviews notices to determine if rejected items might be covered with additional information such as different diagnoses, physician’s explanation of care or different procedure codes or modifiers.

Researches and identifies additional information needed to correct rejected claims and to re-file them. Works closely with physicians and nurses to obtain additional documentation needed. Documents in the patient’s account comments any actions taken, the date and the clerk’s initials.

• Re-files insurance claims as needed. Where possible, when no supporting documentation is needed, re-files claims electronically. If supporting documentation is needed, prints paper claims, attaches supporting documents and mails to the designated carriers.
• Receives paper claims from Data Processing for all primary claims not going electronically, serial claims, secondary claims or claims entered into the system to be re-filed.

Reviews paper claims and separates primary insurance claims from secondary insurance claims. Pulls or prints associated EOB forms. Reviews all paper primary claims to identify internal edit rejection items which need to be corrected prior to sending. Receives and reviews the associated Insurance Control Summary Report to obtain explanations of various rejection codes and to determine which actions need to be taken to correct the claim. Makes needed corrections to each claim to permit re-filing the claim either electronically or by paper. Completes all the steps necessary to create a “clean claim” and mails to the designated carriers, when finished. Receives Blue Cross/Blue Shield Audit Trails from the business office supervisor to balance to the Insurance Control Summary and to correct and re-file any rejected claims.

• Receives the Outstanding Claims Report (insurance follow up report) every other month. Reviews these reports to identify all outstanding claims more than 60 days old. Researches to determine reasons for non-payment and contacts the insurance carrier as necessary to expedite payment. Takes corrective actions as needed and re-files claims to obtain payment.
• Prepares journal entries for insurance refunds with the appropriate codes and determines other adjusting entries needed.

Prepares journal entries for adjusting entries. Holds insurance refund journal entries until refund checks are printed and signed. Receives signed refund checks. Notes on each line of the refund journal the refund check number. Pulls related EOB’s, makes EOB copies and includes copies with each refund check indicating where the refund is to be applied. Gives the white copy of the insurance refund journal to the payment entry clerk to be entered, detaches the yellow copy of the journal, attaches copies of related EOB’s, insurance refund requests and refund checks and keeps on file for future reference. Mails refund checks along with supporting documentation to the appropriate carrier.

• Verifies insurance to ensure contracts are still active.

Infusion Clinic:

Verifies all new insurance benefits for Blue Cross, UNHC and Medicare Advantage Plans. Calls patient and explains benefits and their portion due at the time services are rendered.

• Assists with identifying patients who qualify for patient assistance or copay assistance. Helps patients complete forms for enrollment in the various assistance programs.

Medicare Advantage Reviews:

Contact person to set up reviews. Gather charts and records for the insurance representative to scan. Meet and assist insurance company representatives with the reviews.

• Performs other duties as assigned by the Business Office Supervisor or the Administrator. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, knowledge, skills, abilities and working conditions may change as need evolves. ## Qualifications
• Proficient in proofreading documents for errors
• Excellent phone etiquette and communication skills
• Ability to coordinate multiple projects simultaneously
• Experience with transcribing information precisely
• Strong computer literacy with knowledge of office software applications

Job Type:

Full-time Benefits:

401(k) Dental insurance Flexible spending account Health insurance Life insurance Paid time off

Schedule:

8 hour shift Ability to

Commute:

Anniston, AL 36207 (Required) Ability to

Relocate:

Anniston, AL 36207: Relocate before starting work (Required)

Work Location:

In person