Sr Assoc, Physician Billing

Collaborate with management and peers to ensure all required information is obtained for resolution of charge edits, claim edits, denials, and appeals in a timely manner, while adhering to government/payer regulation and department policy/procedures. With limited supervision, responsible for the timely and accurate submission of all charges and claims as assigned and required to bring issue/problem identification and investigation through to an accepted/successful resolution.

Position Summary

With limited supervision, responsible for the timely and accurate submission of all charges and claims as assigned and required to bring issue/problem identification and investigation through to an accepted/successful resolution. Ensures that daily assignments are complete and that all assigned work is reviewed, submitted, and resolved with the highest degree of accuracy.
Key Responsibilities

• Reviews and verifies all demographic and insurance information utilizing available technologies, payer websites, or by phone contact with third party payers or guarantors.
• Collaborate with management and peers to ensure all required information is obtained for resolution of charge edits, claim edits, denials, and appeals in a timely manner, while adhering to government/payer regulation and department policy/procedures.
• Prepares and submits accurate insurance claims and appeals to payer within required timeframes and in accordance with government/payer regulations and requirements.
• Resolves outstanding charges and claims responding timely and accurately for resolution of outstanding balance while adhering to department policies/procedures.
• Accepts, rejects, and reconciles claims run on timely basis and processes payer response reports in an effective and timely manner.
• Reviews and processes guarantor overpayments per department policies and procedures.
• Responds to inquiries received via telephone and other correspondence from patients/guarantors, insurance carriers, departments/foundations as needed.
• Assist with the training of newly hired staff in process and system navigation

Knowledge and Skills

• Ability to perform at a high level of reliability in all duties.
• Attention to detail, good organizational skills, ability to meet priorities within set timeframes, and ability to work as part of a team.
• Applies critical and strategic thinking.
• Knowledge of consumer & federal rights and regulations.
• Comprehensive ability and knowledge of electronic claims processing, electronic remittance advice, electronic payment posting, and clearinghouse functions.
• Thorough knowledge and understanding of benefits and/or coverage as indicated by third party payer requirements.
• Knowledge of insurance authorizations in relation to medical billing.
• Ability to identify problems and issues of varying complexities and to find effective solutions with few guidelines.
• Ability to take initiative to complete moderately complex assignments.
• Demonstrates professional integrity.
• Ability to train and support other team members.

Education

• High School / GED

Experience

• 2 years of experience in a multi-specialty physician billing or equivalent medical billing experience