Health Claims Editor/Collector - (Tama, IA)

DEPARTMENT : Health CLASSIFICATION : Non-Exempt DUTIES & RESPONSIBILITIES : Responsible for editing claims for all lines of business. Determine appropriate collection action by processing accounts in assigned work queues claims. Responsible for collection follow-up on claims for outpatient clinic, pharmacy and dental office Review accounts to ensure compliance with applicable local, state, and /or federal law and regulations. Responsible for gathering info, making recommendations related to adjustments of uncollectible balances and completing accounts appropriately. Identify accounts which require refunds, calculate refund amounts, and refer accounts to supervisor for approval. Respond timely to incoming correspondence and telephone calls from patients, guarantors, 3rd parties, attorneys and other departments regarding accounts. Interpret benefits, exclusions and accurate reimbursement levels of primary and secondary insurance coverage.