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1C
15 Corporate Services Division
Biller I - RW
Entry-Level JobVerifiedNo experience needed
Career Insights for Medical Claims Processor / Representative
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Scorecard
Based on South Dakota data
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What they do
A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.
$45,209 / year median in South Dakota
-12% projected decline
Job Description
Current Employees:
If you are a current Monument Health employee, please apply via the internal career site by logging into your Workday Account and clicking the "Career" icon on your homepage. Primary Location Rapid City, SD USA Department CS Provider Patient Financial Services Scheduled Weekly Hours 40 Starting Pay Rate Range $16.74- $20.
- Supportive work culture
- Medical, Vision and Dental Coverage
- Retirement Plans, Health Savings Account, and Flexible Spending Account
- Instant pay is available for qualifying positions
- Paid Time Off Accrual Bank
- Opportunities for growth and advancement
- Tuition assistance/reimbursement
- Excellent pay differentials on qualifying positions
- Flexible scheduling
Job Description Essential Functions:
Demonstrates application of compliance standards and payer specific data to properly file claims and ensures prompt, appropriate reimbursement of services and supplies billed to third parties and appropriate payment of services and supplies due from patients, as evidenced by documentation, observation and feedback. Demonstrates a working knowledge of third party payer procedures including, but not limited to: Commercial Payers, Veterans Administration, worker' compensation, third-party liability, county payers, and all other third party contractual agreements as required. Conducts timely follow up of claims. Use tools provided to track and trend patterns of claim submission issues that might require Compliance and Charge master staff to resolve, or HIPAA transaction code set review. Research payer requirements and offer suggestions to leadership for claims submission issues. Maintains and updates appropriate system documentation to provide information regarding claim processing to internal or external customers. Identifies unresolved requests of patient responsibility and transfers account to self pay. Performs duties and provides best customer service using behaviors that demonstrate responsibility and accountability. Participates in departmental activities related to performance improvement and quality control. Demonstrates a working knowledge of denial follow up and first level appeals. All other duties as assigned.Additional Requirements Required:
Education- High School Diploma/GED Equivalent in
General Studies Preferred:
Experience- 1+ years of Clerical Experience; 1+ years of Medical Patient Accounts/Financial Services Experience Education
- Bachelors degree in Accounting, Business, Health Related Field Certifications
- Certified Clinical Account Technician (CCAT)
- Accredited University or accredited training professionals; Certified Patient Account Technician (CPAT)
- Accredited University or accredited training professionals Sedentary work
- Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body.