Principal Medical Claims Specialist – Full Time – Patient Financial Services – Closes 10/03/2021

Principal Medical Claims Specialist
– Full Time
– Patient Financial Services
– Closes 10/03/2021

Tracking Code 20212278 Job Description

JOB SUMMARY: Under general supervision, assists in the preparation and submission of catastrophic health emergency (CHEF) requests; review and track reimbursement request and offsets to ensure accurate adjustment of claims; monitors and ensures timely payment of pended FI claims.

Develop, test, and training of new referral and/or claims procedures.

The following duties are intended to provide a representative summary of the major duties and responsibilities and ARE NOT intended to serve as a comprehensive list of all duties performed by all employees in this classification.

Incumbent(s) may not be required to perform all duties listed and may be required to perform additional, position-specific duties.

REPRESENTATIVE DUTIES

Develops and tests new PRC procedures.

Assists in the implementation of new office processes.

Determines eligibility of catastrophic health emergency fund claims based on Federal guidelines and operating procedures.

Submits requests to the Alaska Area Office for reimbursement and/or recovery.

Tracks, monitors, and reports on CHEF year-to-date activity.

Processes, researches and corrects accounts to verify CHEF-related services paid internally with ANTHC Finance/Accounts Payable.

Ensures correct and prompt resolution of FI claim edits with claims pended with the Fiscal Intermediary; maintaining strong knowledge of system software, master files and interface conversion tables.

Reviews and tracks accounts where reimbursements were requested from the Provider through the Fiscal Intermediary.

Participates in provider reimbursement requests and offsets; ensures accounts are updated to reflect reimbursements and/or offsets.

Verifies all identified insurance carriers for eligibility; confirms carrier policy where additional review is needed as part of the referral pre-authorization and claims payment process.

Posts payments and adjustments in purchase order databases for claims not submitted to the F.I.

(credit and payments or ANTHC checks).

Creates, organizes, corrects, updates and maintains accounts on data spreadsheets.

Assists in decision making processes regarding data.

Trains and mentors staff.

Assists in monitoring of staff in training and beyond.

Takes lead on special projects as assigned to assure completion.

Assists in distributing workload among coworkers; provides assistance to coworkers; monitors and reviews coworkers’ progress.

Acts as a backup to cover multiple positions in office.

Provides assistance to patients, providers, and other external parties.

Performs other duties as assigned.

Required Skills

KNOWLEDGE and SKILLS

• Knowledge of medical billing and accounting procedures and
• Knowledge of claims review, analysis and quality
• Knowledge of commercial insurance and government reimbursement
• Knowledge of basic medical terminology and clinic
• Knowledge of reception, typing, computer operations, and

• Skill in operating a personal computer using a variety of software including medical billing
• Skill in tracking and accomplishing multiple tasks and
• Skill in establishing and maintaining cooperative working relationships with other
• Skill in conducting successful telephone consultations and operating a multi-line office phone

Required Experience

MINIMUM EDUCATION QUALIFICATION

An Associate’s Degree in business, finance or related discipline.

Progressively responsible related work experience may be substituted on a year-for-year basis for college education.

MINIMUM EXPERIENCE QUALIFICATION

Non-supervisory
– Seven (7) years of experience working in a medical office performing medical billing processes.

An equivalent combination of relevant education and/or training may be substituted for experience.

MINIMUM CERTIFICATION QUALIFICATION

N/A

PREFERRED EDUCATION QUALIFICATION

N/A

PREFERRED EXPERIENCE QUALIFICATION

N/A

PREFERRED CERTIFICATION QUALIFICATION

N/A

ADDITIONAL REQUIREMENTS

N/A

WORKING CONDITIONS

The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job:

• This position requires the ability to sit for long periods of
• ANMC is not a latex free environment; therefore, some latex exposure can be

Job Location Anchorage, Alaska, United States Position Type Full-Time/Regular

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Alaska Native Tribal Health Consortium