General Summary
Performs a variety of complex clerical and accounting functions for patient billing, including maintenance of third party billing records and resolution of a variety of insurance issues. Follows up on submitted claims and patient billing; resubmits claims or resolves problems. Works with others in a team environment.
Primary Responsibilities
1. Processes claims to patients and other payers and maintains supporting documentation files.
2. Researches and responds in person, by telephone, or in writing to patient or insurance carrier inquiries regarding billing questions.
3. Follows up on submitted claims; monitors unpaid claims, initiates tracers with EHR software; re-file claims as necessary with standard billing cycle time frame, either electronically, on paper, or on insurance provider web portals.
4. Posts and reconciles payments to patient account inquiry checking each insurance payment for accuracy based on contracted fees.
5. Identifying and billing secondary and tertiary insurances.
6. Reviews accounts receivables and make recommendations to supervisor on delinquent accounts.
7. Review and analyze patient records; keeping track of patient data over unpaid multiple visits.
8. Review for and work rejected and denied claims immediately. Determine why the claim was rejected or denied, correct the issue, document appropriately within the billing notes, and resubmit.
9. Appealed claims will need to work per insurance guidelines.
10. Maintains billing/filing records in accordance with established protocol.
11. Ensures strict confidentiality of financial records as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
12. Performs other duties as assigned.
13. Promote and adhere to CACOST core values (Accountability, Excellence, Integrity, Quality and Teamwork).
Work Experience
- Minimum of one year experience in medical office setting.
- Two years of prior employment experience in medical billing.
Education/Certifications/Licensure
- High School Diploma or equivalent
Skills
- Computer skills and experience in maintaining automated recordkeeping systems.
- Good communication skills, written and oral, are necessary.
- Medical billing certification preferred; not required.
Physical Requirements
If a preliminary offer of employment is extended, a physical will be required before the offer can be accepted.
Light to medium physical duties include standing, walking, reaching, bending, hearing, and talking for up to eight(8) hours a day. Must have good vision; with or without corrective lenses. Must be able to lift twenty (20) pounds. Lifting will be primarily confined to occasional on-premises lifting of boxes of office supplies and minor office equipment.