This position is responsible for the timely follow up of technical or professional medical claims to insurance companies that have been denied, left pending or require remittance. Working aged receivable reports, identifying errors and working claims, calling insurance companies if necessary and posting adjustments and payments as well.
Working overpayment report by identifying refunds due to patient or insurance company and processing request.
Research and appeal denied claims.
Responsible for rebilling of services provided to nursing home patients (dental, podiatry, audiology and optometry).
Responsible for EMR system.
Responsible for posting procedures/modifiers/Dx codes verify for accuracy (providers choose codes, we verify and submit claims out to insurance company), verify insurance accuracy before submitting, working reports for missing charges from providers at a minimum of a weekly basis.
Answering incoming phone calls from facilities, patient or patient's family and field staff about account inquiries.
Maintaining and enhancing knowledge through further education provided by self, other staff or training on our computer via self-guided modules.
Mailing out own correspondence/claims as printed on a daily/weekly basis as needed.
Check eligibility and benefit verification.
Review patient bills for accuracy and completeness and obtain any missing information.
Prepare, review and transmit claims using billing software, including electronic and paper claim processing.
Follow up on unpaid claims within standard billing cycle time frame following prescribed methods.
Updates cash spreadsheet.
Expected to work 450+ encounters per week.
Actively supports and complies with all components of the compliance program, including, but not limited to, completion of training and reporting of suspected violations of law and Company policy.
Maintains confidentiality of all information; abides with HIPAA and PHI guidelines at all times.
Reacts positively to change and performs other duties as assigned.
High school diploma or GED required.
Knowledge of business and accounting process usually obtained from an Associates in Business Administration, Accounting or Health Care Administration rqeuired.
1+ years in a medical office setting.
1+ years of HMO/PPO, Medicare and Medicare, and other payment requirements and systems required.
1+ years of accounting and bookkeeping procedures required.
1+ years of medical terminology required.
Must be able to work well under pressure with hard deadlines.
Use of computer systems, software and calculator.
Effective communication abilities for phone contacts with insurance payers to resolve issues.
Customer service skills for interacting with patients regarding medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
Able to work in a team environment.
Problem-solving skills to research and resolve discrepancies, denials, appeals and collections.
We will only employ those who are legally authorized to work in the United States. Any offer of employment is contingent upon the successful completion of a background investigation and drug screen.
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