Senior Claims Processor - Physician Services

Halifax Health Daytona Beach , FL 32114

Posted 4 weeks ago


Halifax Health is seeking a Senior Claims Processor for the PBFS - Physician Services Department.


This individual is responsible for overseeing and assisting with third party insurance billing, collections and follow-up in accordance to payor and established guidelines of professional services. Assists with third party billing process through the scrubbing, preparation and submission of accurate and complete claims in a timely manner. Assists with effective collection, follow-up and all other communicated activities with third party payors, guarantors and patients for timely resolution of accounts. Monitors to ensure adherence to Halifax Health compliance policies.

Job Qualifications

  • Associate's degree in Business, Accounting, or Finance, or equivalent experience of at least four years, preferably in a medical office or healthcare equivalent setting.

  • Must have thorough knowledge of all healthcare third party insurance billing and coding, as well as collection and follow up processes.

  • Must be familiar with billing and collections related to managed care contracts.

  • Prefer at least two years leadership experience.

  • Must have proficient PC skills and related knowledge.

Job Duties and Responsibilities

  • Assist Supervisor in monitoring Billing System dashboards to ensure accurate and timely submission of all third party claims,

  • Assist Supervisor to ensure achievement of approved goals for collection, A/R days and % of A/R over 90 days. This will include management of timely PBFS charge entry and receipt of data from external sources as well as internal coders to diminish late charges and exceeding filing limits.

  • Monitor billing backlog to minimize days claims are being held and develop processes to ensure timely and correct billing.

  • Monitor to ensure systems, processes, policies and procedures are in place to assure correct payment from all third party payors.

  • Keep abreast of all Medicare & Medicaid, managed care and third party payor bulletins, regulations, guidelines, contracts and forthcoming changes to keep all team members advised and maintain proactive planning to ensure compliance and accuracy in billing and collections.

  • Notifies Physician Services Project Coordinator of physician office and interdepartmental billing issues that may require additional training.

  • Attends pertinent seminars, visits third party payors, and be active in related professional organizations to establish good communications and to keep abreast of changes, resulting in proactive actions.

  • Assists with providing necessary training, information, and tools for employees to perform their jobs effectively and efficiently, and to maintain a competent staff.

  • Contributes to management's effectiveness by identifying short-term and long-range issues to be addressed, providing information and commentary pertinent to deliberations, recommending options, and a course of action.

  • Watch for trends in denials and payment reduction and forwards information to Supervisor, Physician Services Project Coordinator as needed.

  • Researches and/or recommends new processes or systems to improve efficiency and productivity of operations.

  • Reviews adherence to Halifax Health compliance policies ensuring that all team members are familiar with these.

  • Maintains current knowledge of CPT, HCPCS, modifier and ICD10 coding as well as 1500 and UB04 billing requirements in accordance with specific insurance payor guidelines.

  • Make appropriate determination for contractual adjustments as deemed necessary in accordance with insurance payor or Physician Services policies and/or guidelines.

  • Demonstrates the ability to evaluate and resolve accounts in a timely manner by utilizing resources including, but not limited to, bills, remittances, correspondence, ATB's, worklists, payor websites, and phone calls to payors in accordance to payor specific guidelines.

  • Demonstrates the ability to organize work, recognize and establish priorities, and complete all work assignments without creating backlogs.

  • Contributes to effective working relationships by demonstrating a positive and helpful attitude in relationships with co-workers and customers.

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Senior Claims Processor - Physician Services

Halifax Health