• High School diploma; or equivalent combination of education and experience.
• Minimum of three (3) years recent medical billing and collection experience.
• Extensive knowledge in medical billing and government claims, appeals, and contractual payment plans.
• Thorough understanding of ICD-10, CPT, HCPCS, RVS coding and pricing, and fee schedules.
• Knowledge in self-pay collections, third party carrier guidelines; commercial and government contracts including HMO, PPO, Medicare, Medi-Cal, CHAMPUS-TRICARE, CMS, GHPP, and CCS.
• Extensive experience and knowledge of processes related to credit balance resolution and under payment appeals received incorrectly from health plan.
• Knowledge of laws and regulations impacting medical billing and credit balance resolution.
• Proficiency with Microsoft Office products such as Excel and Word.
• A Bachelor's Degree; or equivalent combination of education and experience.
• Epic Resolute Experience.
• Five plus (5+) years’ experience working credit balances from a variety of health plans and funding sources including Government, HMO, PPO, FFS, transplant, etc. • Under payment identification and follow up experience.