Edits Analyst III

Title: Edits Analyst III

POSITION PURPOSE/FUNCTION:

Responsible for accurately updating the patient's demographics and/or insurance information, once entered into the billing system, based on guidelines contained in the departmental Policies and Procedures manual.

RESPONSIBILITIES:

Primary Functions:

• Update the necessary data entered by either the Patient Registration or Insurance Verification clerks based on data contained in the patient's medical record.
• Determine the appropriate insurance carrier and billing information from the data contained in the patient's medical record and use that information to accurately update a patient's account in the billing system.
• When insufficient or questionable data is supplied with the medical record, contact the appropriate insurance carrier to acquire accurate data.
•  Request additional insurance codes from Data Processing as required.
• Request clarification from Supervisor or Lead when necessary in order to assure accurate  data entry.
• Identify and work complex edits presented from various sources.
• Maintain current understanding and observance of policies and procedures as outlined in the departmental Policy and Procedure Manual.
• Be punctual and productively work entire designated shift.
• Limit unscheduled absences to one half day per month.
• Adhere to company dress code by dressing in a neat and professional manner
• Communicate in a respectful and courteous manner at all times with entire staff.

Secondary Functions: 

• All other duties as assigned.
• Actively particpate in meetings and educational programs in an effort to improve both individual and team quality and effectiveness.

• High School diploma
• Proficient computer knowledge

• Basic knowledge of all Microsoft Office Products

• Ability to work equally well individually and in a team environment
• Minimum two years in a medical billing environment
• Minimum two years in a fast-paced production oriented environment
• Minimum two years experience verifying eligibility with various insurance carriers
• Quick learner with an aptitude for custom computer systems
• Previous success and comfort with entering data for extended time periods and limited interruptions