Description
Duties/Responsibilities include but are not limited to:
- Effectively review and research claims denials and contact payers to verify detailed denial reasons when necessary
- Contact patients to obtain accurate insurance information.
- Prepare documentation and file reconsiderations and appeals as appropriate.
- Able to identify and communicate denial/rejection trends to management
- Able to identify and resolve discrepancies
- Navigate and research insurance policies & benefits for policy exclusions for patients.
- Navigate and research payer medical reimbursement policies and exclusions.
- Review and work all daily correspondence received from patients and payers.
- Understand and act on the timely filing guidelines associated with claims filing, reconsiderations, and appeals for assigned payers.
- Review accounts for accuracy (payments and adjustments)
- Knowledge of medical EOB’s, patient deductibles and co pays, and insurance or third-party correspondence
- Experience working with payer websites
- Experience in working aged AR
- EDI transactions/troubleshooting
- Other assigned duties
Requirements
Applicants must have:
- eClinicalWorks experience is preferred
- HST experience is strongly preferred
- Minimum of 2-4 years of medical billing, collections, and/or payment posting experience
- High school diploma or GED
- Candidate must exhibit excellent time management, organizational skills, and be computer literate.
- Ability to prioritize workload
- 10 Key – accuracy and proficiency
- Ability to work independently and adapt to a fast-changing environment
- Knowledge of Medicare, Medicaid, Medicaid MCO’s, and commercial insurance.
- Strong problem-solving and critical thinking skills
- Strong interpersonal and communications skills
- Must have ICD-10/CPT knowledge
- Adhere to all HIPAA guidelines/regulations