This position is responsible for resolution of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.
PRIMARY RESPONSIBILITIES:
- Reviews medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed
- Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation
- Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
- Responsible for working claim rejections in a timely manner
- Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Able to apply correctly to claims/ fee billed
- Processes incoming EOBs to ensure timely insurance filing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
- Responsible for processing payments, adjustments and denials according to established guidelines
- Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts
- Responsible for reconciling transactions to ensure that payments are balanced
- Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures
- Responsible for keeping current with changes in their respective payer’s policies and procedures
REQUIRED QUALIFICATIONS:
- High school diploma or GED equivalent
- Two or more years of relevant experience in the healthcare industry, with a focus on medical terminology and ICD/CPT coding preferred
- Strong attention to detail and professional customer service skills
- Intermediate level with Microsoft Office applications
PREFERRED QUALIFICATIONS:
- Knowledge of submission and re-submission of medical claims
- Government and commercial policies and procedures knowledge.
- Knowledge of ICD, CPT codes and HCPCS coding
- HIPAA compliance rules and regulations
- Skill in the operation of billing software and office equipment
- Skill in processing claims efficiently and on a timely basis
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