Medical Claims Specialist

Job Description

UW Medicine Faculty Practice Plane Services has and outstanding opportunity for a Claims Specialist (Patient Account Representative 2). This position is responsible for claims review, clearing claim edits, and timely and accurate submission of claims (both electronic and paper)

WORKING SCHEDULE:

• Monday - Friday, Full-time

• Remote

PRIMARY JOB RESPONSIBILITIES:

• Review charges that may need to be routed to a different account type (VA, ACC, MVA), create new account types as needed, and add (or link) the correct coverage(s) to the new accounts.

• Review charges for any coverage errors and research available resources (EEV, payer websites, phone call to insurance) to determine correct information needed to clear the charge edit as appropriate.

• Resolve all pre-processing claim edits that indicate errors needing correction. This may involve updating patient registration information, posting rejections, or forwarding the claim to a medical coding specialist for review and coding changes prior to submitting the claim for payment.

• Resolve all coverage/registration denials

• Continuously evaluate own work product to diagnose trends or patterns of errors needing corrections, and make recommendations to management regarding building in new edits, deactivating obsolete edits, or modifying existing edits to improve efficiency.

• Assimilate and operationalize all quarterly/yearly updates to each payer's billing rules, guidelines, exceptions, and carve-outs, making sure we've captured any changes that may require building additional charge edits or claim edits.

• Prepare and submit pre-authorization questionnaires to Qualis or ProviderOne for any Health Care Authority claims requiring pre-authorization.

• Process all account merge requests in a timely manner when it's determined there are duplicate patient accounts in our EPIC billing system.

• Review HMC Trauma Registry daily, flag all trauma-related accounts with UWPTRM patient notice, and follow up with Harborview staff to obtain ISS scores.

• Complete retro adjudication (VFO) process using assigned work queues when new coverages are added to patient accounts by other areas, including reviewing for incorrect payments from insurance or patient, and rebill charges accordingly.

• Update or correct patient registration/demographics on accounts in the EPIC billing system.

• Update/edit charge entry detail for Medicare claims that have been corrected and need to be resubmitted electronically.

• Research and navigate a variety of databases to obtain/verify claim/eligibility information via payer websites and/or confer with payers by phone.

• Process claim attachments and secondary claims.

• Review and identify corrected claims to ensure that all necessary documentation is compiled for submission to payers.

MINIMUM REQUIREMENTS:

• High School graduation or equivalent AND two years of experience in patient accounting, customer service, or a related office environment.

• Equivalent education and/or experience may substitute for minimum qualifications except when there are legal requirements, such as a license, certification, and/or registration.

UW Medicine Faculty Practice Plan Services (FPPS) supports UW Physicians (UWP) , a practice group for more than 3,000 physicians and other healthcare professionals associated with UW Medicine. UW Medicine includes Harborview Medical Center, UW Medical Center - Montlake, UW Neighborhood Clinics, UW Medical Center - Northwest, the UW School of Medicine, Valley Medical Center, and Airlift Northwest. UWP members also practice at the Seattle Cancer Care Alliance, a partnership of UW Medicine, Fred Hutchinson Cancer Research Center, and Seattle Children's Hospital.

Compensation, Benefits and Position Details

Pay Range Minimum:

$47,724.00 annual

Pay Range Maximum:

$68,244.00 annual

Other Compensation:

Benefits:

For information about benefits for this position, visit

Shift:

First Shift (United States of America)

Temporary or Regular?

This is a regular position

FTE (Full-Time Equivalent):

100.00%

Union/Bargaining Unit:

SEIU Local 925 Nonsupervisory

About the UW

Working at the University of Washington provides a unique opportunity to change lives - on our campuses, in our state and around the world.

UW employees bring their boundless energy, creative problem-solving skills and dedication to building stronger minds and a healthier world. In return, they enjoy outstanding benefits, opportunities for professional growth and the chance to work in an environment known for its diversity, intellectual excitement, artistic pursuits and natural beauty.

Our Commitment

The University of Washington is proud to be an affirmative action and equal opportunity employer ( . All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, national origin, age, protected veteran or disabled status, or genetic information.

To request disability accommodation in the application process, contact the Disability Services Office at or .

Applicants considered for this position will be required to disclose if they are the subject of any substantiated findings or current investigations related to sexual misconduct at their current employment and past employment. Disclosure is required under Washington state law ( .

University of Washington is an affirmative action and equal opportunity employer. All qualified applicants will receive consideration for employment without regard to, among other things, race, religion, color, national origin, sexual orientation, gender identity, sex, age, protected veteran or disabled status, or genetic information.