JOB DESCRIPTION

• Correct payer rejections in the electronic clearing house data base
• Send patient statements
• Take patient calls in reference to billing
• Work all insurance claims on AR reports for facilities assigned
• Work correspondence
• Write appeal letters for claim denials such as contractual allowable, medical necessity, and coding issues

Required Skills

ADVANTX PROCEDURES

• Ability to interact with team members, management and facility

• Ability to read and interpret the ledger, and decipher any corrections which need to be made to ensure patients are being billed correctly

• Ability to write detailed appeals for reimbursement based on contracted amounts and clinical policy guidelines

• Builds a patient statements file in Advantx to upload to Zirmed weekly

• Ensure all hold claims are filed within 30 days or date of service

• Knowledge of Advantx registration, billing transaction modules

• Knowledge of procedures for working correspondence

• Knowledge of how to documents accounts in Advantx correctly

• Knowledge of backup needed for adjustments and refund request

• Knowledge of facility Managed Care Contracts

• Knowledge of required detailed accurate information policies and procedures

• Notify Facility and/or Management of any discrepancies

• Understands all areas covered in Registration/Case History

• Understanding and basic knowledge of CPT and ICD.10 codes

• Verifies data on EOBs and PAS for accuracy

• Verifies proper Managed Care Plan and contract allowable prior to calling on claims, working correspondence, or submitting appeals

• SCAN CHART

  • Knowledge of how to pull medical records in order to submit to the insurance companies for review
  • Knowledge of how to research payments/EOBs
  • Knowledge of how to scan documents in for the Collection department
  • Knowledge of how to work correspondence and ensure it has been worked

• WAYSTAR

  • Knowledge of how to correct claims and resubmit through Waystar
  • Knowledge of how to review claims submitted through Waystar
  • Payer rejections are worked daily
  • Upload “Patient Statements” file from Advantx so statements process weekly

Required Experience

REQUIRED EXPERIENCE

• Computer experience required
• Forty-five (45) wpm typing skills
• Knowledge of CPT and ICD-10 codes
• Good communication skills: written and verbal
• Medical terminology and computer experience beneficial
• Must have the skills necessary to operate the office equipment required to fulfill job duties
• Two years previous experience in Ambulatory or Hospital collection, billing, or payment posting preferred

ADVANTX PROCEDURES

• Ability to interact with team members, management and facility

• Ability to read and interpret the ledger, and decipher any corrections which need to be made to ensure patients are being billed correctly

• Ability to write detailed appeals for reimbursement based on contracted amounts and clinical policy guidelines

• Builds a patient statements file in Advantx to upload to Zirmed weekly

• Ensure all hold claims are filed within 30 days or date of service

• Knowledge of Advantx registration, billing transaction modules

• Knowledge of procedures for working correspondence

• Knowledge of how to documents accounts in Advantx correctly

• Knowledge of backup needed for adjustments and refund request

• Knowledge of facility Managed Care Contracts

• Knowledge of required detailed accurate information policies and procedures

• Notify Facility and/or Management of any discrepancies

• Understands all areas covered in Registration/Case History

• Understanding and basic knowledge of CPT and ICD.10 codes

• Verifies data on EOBs and PAS for accuracy

• Verifies proper Managed Care Plan and contract allowable prior to calling on claims, working correspondence, or submitting appeals

• SCAN CHART

  • Knowledge of how to pull medical records in order to submit to the insurance companies for review
  • Knowledge of how to research payments/EOBs
  • Knowledge of how to scan documents in for the Collection department
  • Knowledge of how to work correspondence and ensure it has been worked

• WAYSTAR

  • Knowledge of how to correct claims and resubmit through Waystar
  • Knowledge of how to review claims submitted through Waystar
  • Payer rejections are worked daily
  • Upload “Patient Statements” file from Advantx so statements process weekly