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 committed to fostering an inclusive, respectful and welcoming community for all. As an equal opportunity employer, the University considers applicants for employment without regard to race, color, creed, religion, national origin, citizenship, sex, pregnancy, age, marital status, sexual orientation, gender identity or expression, genetic information, disability, or veteran status consistent with UW Executive Order No. 81. To request disability accommodation in the application process, contact the Disability Services Office at 206-543-6450 or [email protected]. 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. Use the filters or enter keywords in the search box (such as “custodian,” “nursing” or “manager”) to explore available opportunities. To find temporary opportunities, enter “temporary” in the search box. If you are a current UW employee: You must log into Workday and apply internally through the UW Jobs Hub. Looking for faculty, librarian or academic staff positions? Please visit our Academic Jobs site. Looking for student employment? Learn more on our Student Employment site. There are many perks to working for the University of Washington. Learn more about the benefits that could be available to you as a UW employee. 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