This position is responsible for the 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 resubmission 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
• Superior interpersonal and problem-solving skills along with a high initiative to succeed

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