Responsible for accurate and timely review of submission of all patient claims through electronic filing technology that includes: PCACE, MNITS, Direct Date Entry (DDE), Express Plus as well as manual hard copy mailing. This requires a knowledge of CPT codes, diagnosis codes and modifiers. This also requires an ability and understanding to combine claims and identify possible duplicate, erroneous and/or missed charges. This position frequently interacts with Clinic Referrals & Hospital Utilization Review to verify receipt of appropriate referrals, pre-certs, and authorizations. This position requires knowledge of payor contract language to ensure all responsibilities are carried out in accordance with payer specific rules and regulations. Develop and maintain a liaison with insurance companies, health maintenance organizations, managed care contract companies, government payers and third party payers. This relationship will assist in facilitating clean, efficient and timely claims submission, denial management coordination and timely revenue reimbursement of clinic and hospital inpatient/outpatient services.
Two years post high school education and/or job experience in a business or healthcare related field.
OTHER EDUCATION/TRAINING/EXPERIENCE PREFERRED: Strong personal computer skills including knowledge of Windows, MS Word, MS Excel, MS Outlook, Meditech and LSS helpful. CPT and ICD-9 knowledge helpful. Qualified candidate must be able to adjust to the fast paced and changing environment of the health care industry. Candidate must be customer service oriented and possess strong skills in:
License or Certification:
Schedule Details:M-F 8am-5pm
Staffing Specialist:Marnie Thompson
Mayo Clinic is an affirmative action / equal opportunity educator and employer.