Under general supervision monitors and initiates claim appeals on all insurance claims and pending receivables after final bill. This position will be expected to maintain a comprehensive understanding of general coding and billing compliance, the adjudication process and contractual obligations specific to various payers.
- Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal
- Understanding of reason and denials codes from payors. Able to resolve claim denials based on reason codes
- Verify patient eligibility and resolve any problems
- Contact customers to verify insurance information
- Contact insurance companies to resolve payment issues
- Identify areas for improvement within the billing department
- Work to decrease A/R days to industry standards
- Identifies payor trends and works to resolve
- Correct claims for re-submission
- Assists with monthly close functions
- Ability to establish and maintain effective working relationships
- Able to reach and maintain department productivity and quality goals
- Ability to meet individual and team goals with minimal errors as assigned by the Billing Manager Uphold Medicare, Medicaid, and HIPAA compliance guidelines in relation to billing, collections, and PHI information
- Participates in educational activities and attends staff meetings
- Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations
Required Skills
- Minimum 3-5 years of insurance billing and collection experience
- Knowledge of business office procedures
- Knowledge of paper and electronic claim requirements
- Expert knowledge on insurance and reimbursement process
- Familiarity with HIPAA privacy requirements for patient information. Maintains and protects confidential information
- Understanding of medical ICD 10 codes and CPT medical billing codes
- Proficient in use of computers and common office equipment
- Good math and data entry (typing) skills
- Ability to read, understand and follow oral and written instructions
- Exercises good judgment and discretion
- Good verbal and written communication skills
- Good telephone and patient relation skills
- Detail oriented and ability to prioritize work
- Works with minimal direction and oversight
Millennium Health offers a competitive, comprehensive benefits package.
Millennium Health is an Equal Opportunity/Affirmative Action employer and E-Verify participant. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, gender identity, sexual orientation or protected veteran status
https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm
Required Experience