Claims Analyst

Claim Analyst

At Virginia Garcia Memorial Health Center, we welcome diversity; we encourage, uplift, and are honored to serve people who have been historically underrepresented and underserved. Our mission is to provide high-quality, culturally appropriate healthcare to low-income residents of Washington and Yamhill Counties, with a special emphasis on seasonal and migrant farm workers and others with barriers to receiving healthcare. We strive to provide an inclusive environment that welcomes and values the diversity of the people we employ and serve.

Job Summary: The Claim Analyst is responsible for processing payment of all claims that are entered and billed out of Virginia Garcia Clinics. This role functions as a member of the administrative team representing the billing, reconciliation, appeals, and collection of payments for the Center.

Essential Duties and Responsibilities:

Verify that each patient's demographic information has all the required information completely and correctly entered into the computer by front desk staff in clinics.

Communicate with the front desk personnel and work closely assisting them with any questions on entering correct insurance information into the computer system.

Verify, correct, and update any insurance information that has been entered into the computer system.

Post all insurance payments and adjustments and enter all correspondence from patients and insurance companies into the computer system.

Correct and refile any denied claims within timely filing limits set forth by VGMHC contracts.

Appeal and research any claims that are denied after they have been corrected and refiled.

Know when it is appropriate to communicate with providers if an addendum needs to be added to a chart note so a claim can be corrected due to coding requirements of ICD9/10.

Process and follow up on all assigned work queues to meet VGMHC guidelines for number of days in A/R.

Follow all criteria required to allow for APM payments.

• Perform other duties as assigned.
• Handle protected health information (PHI) in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

HIPAA Requirements:

The Claim Analyst will have access to PHI in the course of his/her duties. The Claim Analyst uses PHI for all aspects of billing, patient's accounts and communications with insurance companies. Applying the minimum necessary standard of HIPAA, the designated record sets to which this employee will have access to: all information in the practice management system, the full medical record, end of day reports from the practice management system, encounter forms, all communications from insurance companies, all collections information.

Knowledge, Skills and Abilities Required:

• Knowledge of a wide range of medical, dental, mental health billing procedures, coding and forms.

Must be familiar with all insurance types, including commercial, MVA, WC, Medicare and OHP plans and their guidelines and maintain up to date knowledge.

• Familiar working with online eligibility systems and clearing houses to download remittances, denials, etc.
• Must be able to be certified as Care Oregon Application Assistant.
• Understand how to read insurance Explanation of Benefit documents and post payments and write offs according to VGMHC contracts.

Proficiency in English, both spoken and written required.

Proficiency in Spanish preferred.

• Proficient using a computer and 10-key.
• Familiar with Microsoft Office Word and Excel
• Ability to communicate effectively and professionally with patients, co-workers, insurance company personnel, and governmental billing personnel.
• Willing to support team members to accomplish daily activities.
• Detail oriented

Education and Experience Required:

• Minimum one year experience in medical/behavioral health/dental billing (ICD-10 CPT and HCPCS).
• High School Diploma or equivalent, associate degree preferred.
• Certificate in Billing and Coding preferred.
• Experience with medical terminology preferred.
• Experience with dental terminology preferred.
• Certification as Care Oregon Application Assistant or ability to be certified within 90 days of hire.

Behavioral Competencies:

Accountability: Role model VG's mission, vision, and shared values

Customer-Focus: Listen to the voice of the customer and strive to delight them by exceeding their expectations

Teamwork: If someone needs help, help them

Initiative: Be innovative, apply fresh ideas, and continuously improve how you do your work

Confidentiality: Maintain strict confidentiality and respect the privacy of others

Ethical: Demonstrate integrity, honesty, and stewardship in all encounters at work

Respect: Demonstrate consideration and appreciation for co-workers and patients

Communication: Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others

Physical Requirements:

• Sitting: up to 90%
• Standing: up to 10%
• Walking: 10%
• Stooping: 10%
• Reaching: 10%
• Use of computer: 90%
• Must be able to lift/carry up to 25 lbs.

Immunization:

Staff member must meet immunization requirements as stated in VGMHC's immunization policy and state and federal guidelines.

Job description represent a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHC's Mission.

VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes affirmative action in the area of placement, promotion, transfer, rate of pay and termination.