Chapter 1: Electronic Claims Processor

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Chapter 1 1. Electronic Claims Processor 2. hospitals, acute care hospitals, skilled nursing or long-term care facilities, rehabilitation centers, and ambulatory surgical centers 3. physician assistant, nurse practitioner, advanced registered nurse practitioner, certified nurse anesthetist, physical therapist, speech therapist, licensed clinical social worker, and certified registered nurse practitioner 4. Insurance Billing Specialist, Multiskilled Health Practitioner (MSHP), and Claims Assistance Professional (CAP) 5. Review Documentation, Review Diagnostic and Procedural Coding, Submit Insurance Claims, Collect data required for billing from all health care providers, hospitals, outpatient clinics and laboratories, Act as an insurance counselor, Provide credit counseling, Answer routine enquiries related to account balances and insurance submission dates, Assist patients in setting up a payment schedule, Follow up on delinquent accounts, Trace denied, adjusted, or unpaid claims 6. They help patients organize, file, and negotiate health insurance claims; assist the consumer in obtaining maximum benefits; and tell the patient how much to pay the providers to make sure there is no overpayment OR review and analyze existing or potential policies; render advice; and offer counseling,…show more content…
Solid foundation and working knowledge of medical terminology, including anatomy, physiology, disease, and treatment terms, as well as the meanings of abbreviations; Expert use of procedural and diagnostic code books and other related resources; Precise reading skills; Basic mathematics; Knowledge of medico legal rules and regulations of various insurance programs; Knowledge of compliance issues; Basic keyboarding and computer skills; Proficiency in accessing information through the Internet; Knowledge of billing and collection techniques; Expertise in the legalities of collection on accounts; Generate insurance claims with speed and

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