SUMMARY: Reporting to the Revenue Cycle Manager,this task-oriented individual is responsible for ensuring the organization meets its desired patient revenue goals by maintaining weekly claims processing, monitoring aging reports, monitoring unprocessed/denied claims and collections of private pay, insurance and fee for service claims. ESSENTIAL DUTIES AND RESPONSIBILITIES:The following are indicative of the essential functions required to perform this job successfully. Other duties may be assigned by management. Ensure all claims are submitted with a goal of zero errors by reviewing prior to submission, CPT, ICD-10, Modifiers, HCPCS codes, insurance information, location and provider errors. Resolve insurance accounts, analyzing and reviewing for payment resolution, working all assigned rejections and denials. Prepare and send written appeals when necessary with appropriate documentation. Answer incoming telephone calls from Payers and patients, provide answers to questions and concerns about billing statements and accepting payments from patients' over the phone. Work exception reports and review EOB's for correct insurance payment. Accurately document in the system on a specific account and date of service. Notify the Revenue Cycle Manager of any problems with patient claims or insurance companies. Meet or exceed all goals set by Revenue Cycle Manager Maintains current knowledge of state and federal billing requirements and regulations Responsible for the maintenance of patient confidentiality and adherence to Patient Rights and Responsibilities, as issued in the New Hire Orientation Adhere to all MWCHC policies and procedures Accurate electronic charge entry which includes review of CPT codes, ICD-9 codes, HCPCS codes, patient information, insurance information, provider and charge information Maintaining claims processing productivity through accurate and complete claim submissions Ability to analyze EOB denials and determine steps necessary to correct claims. Ensures ongoing management of the AR based on the organization's goal. Including monitoring of aging reports, timely follow up on insurance claim status, resolution of denials/rejections, re-submission of claims, and file appeals Respond to inquiries from insurance companies, patients and providers Ensure compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. Assist with auditing data within the practice management system for accuracy and validity. Perform additional duties as requested by Supervisor or Management team. Maintains current knowledge of state and federal billing requirements and regulations Responsible for the maintenance of patient confidentiality and adherence to Patient Rights and Responsibilities, as issued in the New Hire Orientation Assist in training new employees/interns as needed. Adheres to all MWCHC policies and procedures Possesses the ability to get along with co-workers, patients and visitors Performs all other duties as assigned by management  |