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Medical Biller - Claim Follow Up / Payment Poster / Customer Service

Job Description

Medical Billing Positions Available!

We have positions open in Customer Service, Claim Follow Up, and Payment Posting

The Claim Follow up Specialist is responsible for account resolution and resolving issues associated with unpaid/improperly filed insurance claims.

  • Ensures timely, effective and thorough management of physician practice claims to ensure full, expected reimbursement for services provided
  • Accesses claims from the work queue and queries claim status with the payor, utilizing all appropriate systems to effectively research the claim
  • Prioritizes claims based on aging and outstanding dollar amounts, or as directed by management
  • Works on assigned claims and completes all necessary activity as defined in departmental policies and procedures
  • Researches and/or ensures that questions and requests for information are addressed in a timely and professional manner to ensure resolution of outstanding claims
  • Completes follow-up with patients to obtain additional information, when necessary
  • Executes the rebilling or reprinting of claims as necessary
  • Verifies receipt of necessary billing information and confirms if additional information is required from the payer to reduce variances, rejections or denials on patient claims
  • Completes and/or requests adjustments to a claim, as appropriate, based on the dollar threshold of the adjustment
  • Reviews, works and reports all claims that have aged more than the specified grace period stipulated in the policies and/or contracts 
  • Tracks and reports violation of prompt pay or adjudication terms by payers
  • Follows up with payers, proactively, to provide necessary additional documentation for claims that have been reviewed by payers and are awaiting documentation to determine adjudication
  • Escalates claim resolution to management when necessary
  • Organizes work/resources to accomplish objectives and meet deadlines
  • Maintains compliance with federal, state and local regulations, HIPAA and the Corporate Responsibility Program
  • Maintains the privacy and security of all confidential and protected health information.  Uses and discloses only that information which is necessary to perform the function of the job
  • Demonstrates the willingness and ability to work collaboratively with other key internal and external staff to obtain necessary information to address collections issues 
  • Reports posting issues and trends to appropriate CBO management personnel and works collaboratively to develop solutions
  • Participates in all educational activities and demonstrates personal responsibility for job performance
  • Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities, as deemed appropriate
  • Uses supplies and equipment effectively and efficiently
  • Consistently demonstrates a positive and professional attitude at work
  • Maintains stable performance under pressure and handles stress in ways to maintain relationships with patients, customers and co-workers
  • Maintains compliance with established corporate and departmental policies and procedures
  • Performs ongoing monitoring and follow-up of claims worked to ensure maximization of collection dollars
  • Documents all follow-up activities in Epic.

Job Requirements

Education:

  • High School diploma or GED required, associate degree preferred
  • Business courses such as medical terminology, accounting, finance, cash applications, typing, and word processing

 

Experience: 

  • Minimum of 1 -2 years business office experience in a healthcare environment.
  • Experience in claim follow-up in a Physician practice environment preferred.
  • Excellent phone etiquette and internal/external customer service skills required.
  • Ability to communicate and work with payers to get claims resolved and paid accurately.

 

Specialized Knowledge/Skills:

  • Experience with Microsoft Word and Excel preferred
  • Demonstrate in-depth knowledge and experience in the following technology solutions; patient accounting systems, optical imaging, scanning and internet-based insurance websites.
  • Extensive knowledge of Medicare and Medicaid regulations and other insurance guidelines preferred.
  • Medical terminology, knowledge of insurance and reimbursement procedures preferred.

Job Snapshot

Contact Name n/a
Contact Phone n/a
Post Date 7/10/2014
Location Blue Ash, OH
Employment Type Full-Time
Job Type Health Care, Other
Education High School
Experience At least 2 year(s)
Manages Others Not Specified
Industry Healthcare - Health Services, Insurance
Required Travel None
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