Complete all actions: write offs, resubmits, calls, e-mails and post V-lookup denials and action codes from denial log spreadsheet. Work with payer relations and/or payer directly to resolve outstanding issues affecting payment.
Numbers & Facts
Location
Mason, Ohio
Description
Collections Claims Clerk requires:
Claims
Collections
V-lookup denials and action codes from denial log spreadsheet.
Run query to pull in batch and check numbers associated with claims.
Research credits to determine whether there are two payments applied to the claim or if there is an overpayment.
Determine whether a refund is due to insurance or member.
If there is a refund due, complete refund request. If there are two payments applied and one belongs to a different invoice, complete redirect.
Open claims with no payment, nor denial, see resubmit instructions.
If a claim has already been resubmitted and still neither payment, nor denial has been received, contact payer to check status of the claim and work towards a resolution.
Once all actions have been determined, send write offs for approval to supervisor. For all write offs over $1000, they must be approved by finance manager.
Identify trends within payers to find issues. If there is an issue within plan set up, forward it to be corrected. Work with payer relations and/or payer directly to resolve outstanding issues affecting payment.
Complete all actions: write offs, resubmits, calls, e-mails and post V-lookup denials and action codes from denial log spreadsheet.
Run query to pull in batch and check numbers associated with claims. Research in Filebound for additional denials.
Research credits to determine whether there are two payments applied to the claim or if there is an overpayment. Determine whether a refund is due to insurance or member. If there is a refund due, complete refund request. If there are two payments applied and one belongs to a different invoice, complete redirect.
Open claims with no payment, nor denial, see resubmit instructions.
If a claim has already been resubmitted and still neither payment, nor denial has been received, contact payer to check status of the claim and work towards a resolution.
Once all actions have been determined, send write offs for approval to supervisor. For all write offs over $1000, they must be approved by finance manager.
Identify trends within payers to find issues. If there is an issue within plan set up, forward it to be corrected. Work with payer relations and/or payer directly to resolve outstanding issues affecting payment.
Complete all actions: write offs, resubmits, calls, e-mails and post for auditing.