Job responsibilities include those listed in competencies document
Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values.
Responsible for efficient and effective follow-up on third party payers to determine why payment has not been received within a specified amount of time.
Reviews and interprets payer remittances for the purpose of verifying accuracy of payments, adjustments and to determine appropriate action to be taken on denied claims, per guidelines.
Initiates appeals for denied claims per payer guidelines.
Reviews patient account files as necessary for accuracy of information, necessary signatures, pre-certification, insurance benefits, and deposits made.
Submit electronic and hard copy claims in an accurate and timely manner and makes all necessary corrections to the claims that do not pass the billing edits and payer requirements.
Contact payers for status of unpaid claims and research to ensure that questions and requests for information are addressed in a timely and professional manner to facilitate resolution and reimbursement.
Assure timely, effective, and thorough management of claims to ensure full, expected reimbursement for services provided.
Reviews and resolves credit balances in an accurate and timely manner according to policy.
Obtain patient payments and/or set up payment plans according to policy and document any payment arrangements on patient account. Prepares accounts with outstanding balances for the collection agency.
Understands and complies with processes for corrected claims, per payer guidelines.
Maintains knowledge of payor guidelines for assigned specialties.
Prioritize claims based on aging and outstanding dollar amounts or as directed by management.
Answer telephone calls from patients and other callers promptly and with courtesy, demonstrating service excellence as a top priority.
Communicates payer trends or problems identified as impacting reimbursement to the management team.
Manage their time to meet collection goals and productivity standards as defined by the management team.
Participates in quarterly AR meetings with the assigned Medical Practices and educational sessions.
Ability to look up ICD-10 and CPT Treatment codes from online service or using traditional coding reference.
Regularly meets with the Billing Manager to discuss and resolve reimbursement issues or billing obstacles.
At least 3 years’ experience in a computerized physician office or hospital setting in insurance, billing and reimbursement. Thorough knowledge of regulations relating to Medicare, Medicaid, Worker’s Compensation, and commercial insurance.
Demonstrates the ability to work independently and prioritize a heavy workload in a fast paced environment. Strong emotional maturity. Strong time management, organizational and written/verbal communication skills. Must have strong problem solving, attention to detail and accuracy skills. Proficiency in Microsoft Word, Outlook and Excel. Proficiency in Math and Medical Terminology. Ability to maintain highly sensitive and confidential information.
Minimum of a High School Diploma/Equivalent from an accredited school required