60 Waverly Risk Manager Jobs Hiring Near You

FTE/Scheduled Weekly Hours:
1.00 / 40 / 1st Shift (United States of America)
PRIMARY FUNCTIONS
Responsible for the filing of claims to third party payers for services provided to insured patients, resolving errors and issues with payments and assuring correct reimbursement is obtained. Assists patients with insurance or charge related questions.
ESSENTIAL DUTIES AND RESPONSIBILITIES
1. Accurately and efficiently reviews and files all types of claims for hospital inpatient and outpatient services to both primary and secondary payers. Analyzes accounts that have payer specific edits, timely filing limits, or need to be filed manually (paper claim), contacts payers and makes corrections needed to pass claims on for payment.
2. Review denied claims and claim lines, correct errors and submit corrected claims. Identify trends and help complete root cause analysis to determine actions needed to prevent future denials.
3. File appeals and reconsideration requests on partial or fully denied claims; submit documentation as required to obtain payment.
4. Follows up on unbilled and unpaid claims in a timely manner; pays attention to timely filing requirements in order to avoid write-offs. Regularly works all work queues and aging reports according to standards.
5. Thoroughly documents activities on patient accounts to provide useful information to others who may view the account and avoid incorrect or duplicate activities.
6. Resolves patient inquiries, complaints, and problems regarding their accounts or refers to next appropriate level.
7. Helps cover the workload of other team members when they need assistance or are out of the office; helps cover department workload during staff shortages.
MINIMUM QUALIFICATIONS
Education, Experience, and Training

• High school diploma or equivalent.
• Minimum of two years medical insurance experience is preferred.
• Basic knowledge of CPT codes and modifiers is preferred.
• Strong organizational skills.
• Strong oral and written communication skills.
• Ability to learn and navigate computer systems including the online training modules, the employee timesheet and the performance appraisal system. Job specific systems are also required.
• Able to read, speak, and write fluent English.

Physical Requirements

• Sitting - Approximately 100% of shift.
• Standing - Not a requirement.
• Walking - Not a requirement.
• Lifting - Not a requirement.
• Twisting - Not a requirement.
• Bending - Infrequent.
• Squat/Kneel - Not a requirement.

WORK ENVIRONMENT
1. May come in contact with hazardous chemicals or treatment modalities.
2. The possibility exists of exposure to communicable disease due to working in a healthcare environment.
3. Involvement in patient care may result in unavoidable work-related illnesses.
This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. A review of this description has excluded the marginal functions of the position that are incidental to the performance of fundamental job duties. All duties and responsibilities are essential job functions. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by his/her manager.
Requirements are representative of the minimum levels of knowledge, skills, and/or abilities. To perform this job successfully, the employee will possess the abilities or aptitudes to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees. All requirements are subject to possible modification to reasonably accommodate individuals with disabilities.
This document does not create an employment contract, implied or otherwise, other than an "at will" employment relationship with the Waverly Health Center.
This job description in no way states or implies that these are the only duties to be performed by the employee occupying this position. A review of this description has excluded the marginal functions of the position that are incidental to the performance of fundamental job duties. All duties and responsibilities are essential job functions. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by his/her manager.
Requirements are representative of the minimum levels of knowledge, skills, and/or abilities. To perform this job successfully, the employee will possess the abilities or aptitudes to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health and safety of themselves or other employees. All requirements are subject to possible modification to reasonably accommodate individuals with disabilities.
This document does not create an employment contract, implied or otherwise, other than an "at will" employment relationship with the Waverly Health Center.