KEY DUTIES AND RESPONSIBILITIES
- Responsible for monitoring all claim statuses to ensure that all claims are reimbursed and no claims is denied for timely filing
- Responsible for monitoring and/or adjudicating claims that have denied for coding issues
- Post and balance bulk payments from all payor classes to patient accts within 3 days of receipt with 95% accuracy.
- Post Credit Card transactions within 3 days of receipt with 95% accuracy.
- Post adjustments according to the payment rate at the time of service when required by and all contracted payers and government payers within 3 days of receipt with 95% accuracy.
- Pick up bulk copayments from each clinic weekly, review patient account for accurate posting, and prepare for deposit within 3 days of receipt with 95% accuracy.
- Print and post EOBs for daily EFTs.
- Post and reconcile zero balance EOBs- When insurance companies recoup/pay in bulk and no payment is received.
- Post denial transactions from the EOBs received.
- Run daily reports for posting total and balance with daily deposits.
- Pull copies of backup for the overpayment accounts.
- Work the Negative Balance Report on a bi-weekly basis.
- Review and appeal unpaid and denied claims.
- Work directly with the insurance company, healthcare provider, and patient to get a claims processed and paid.
- Note patient accounts when needed.
- Communicate any patient insurance issues to the Patient Access Manager for follow up.
- Answer patients billing questions.
- Handle collections on unpaid accounts as directed by the AR supervisor.
- Update job knowledge by participating in educational opportunities.
- Other duties as assigned by Billing Management.
- Minimum two years of college required
- Three years of Medical coding experience including ICD 9/10 and HCPS coding including
- Three years of Medical Billing and Collection experience required including third-party operating procedures and practices
- Experience working with Electronic Health Records.
- Experience with OIG Healthcare Billing Guidelines and Compliance.
- Experience utilizing payer specific guidelines for billing for reimbursement.
- Experience with all aspects of electronic and paper billing including ANSI codes, clearinghouse functions, payer specific claim formats, UB04 and HCPCS.
- Experience with denial management including understanding the ERA, reviewing medical documentation to determine coding errors and payer specific errors.
- Experience with payer specific resubmission processes
- Microsoft Word, Excel and Outlook required
- Experience with Excel data reporting
- Ability to multi-task effectively under stress, prioritize and meet deadlines with strong attention paid to detail of work produced.
SKILLS & COMPETENCIES
- Ability to accurately determine denial reasons using specific knowledge of ICD1 and HCPC codes
- Ability to effectively determine denial reasons for payer specific denials
- Ability to read an Explanation of Benefit and Electronic Remittance Advice documents
- Ability to work with the clearinghouse with claims submission and statuses
- Ability to utilize payer specific guidelines to receive full reimbursement
- Necessary technical skills to use electronic health record, incident reporting system, email, and other
- Knowledge of legal, regulatory, and policy compliance issues as they relate to medical coding, billing and documentation.
- Ability to submit claims with 95% accuracy to receive reimbursement including claims submitted both on the UB04 and the CMS1500.
- Ability to take initiative to follow up and make sure all claims are adjudicated.
- Ability to manage claims and delegate to other staff for adjudication.
- Regular attendance and punctuality as well as the ability to schedule work production to meet timeliness.
- Critical thinking and the ability to use independent judgement to manage and impart confidential information is required.
- Skill in answering a telephone in a pleasant and helpful manner.
- Ability to establish and maintain effective working relationships with patients, employees and the public.
- Ability to communicate, both orally and in writing, in a professional manner when dealing with employees, management, patients and insurance payers.
- Ability to handle multiple tasks and to prioritize their importance.
- Must be well organized and detail-oriented.
ESSENTIAL PHYSICAL REQUIREMENTS
- Ability to meet attendance Monday Friday 8:30 a.m. – 5:00 p.m.
- Ability to work in a fast paced environment.
- Ability to work on the computer for long periods of time.
- Ability to perform focused work with close attention to detail.
- Ability to operate office equipment, including computers, fax machines and phones.
- Good speaking and listening skills.
- Skilled in data entry.
- Ability to interact with others, both in person and through phone, email and written correspondence.
Job Type: Full-time
Salary: $37,000.00 /year
- Medical Billing and Collection: 3 years
- Medical Billing And Coding: 3 years