li>Demonstrate proficiency in at least one or more of the following: Billing processes of at least one specific payer's billing and collection practices; Account Follow-Up processes of at least one specific payer's billing and collection practices including credit balance resolution; Denials management processes to include denial/claim research, filing appeals, and resolution of denied patient accounts; Payment Posting and Cash Reconciliation processes; Self-Pay Processing / Customer Service including qualifying accounts for charity care, bad debt, and credit balance resolution. ESSENTIAL JOB FUNCTIONS:
- Reviews institutional and professional claims for appropriate use of procedure, modifiers and diagnostic codes to ensure maximum reimbursement using electronic billing systems and in-house computer systems to edit, modify, or change information on the UB04 and CMS-1500 claim forms for Medicare, Medicare Advantage, Medicaid/TennCare, BCBS, Commercial, and/or other third-party payers.