Summary/Objective

Primary duties include, but are not limited to: consistent follow-up on unpaid claims utilizing monthly aging reports and filing appeals when appropriate to obtain maximum reimbursement. Secondary duties include but are not limited to: data entry of all patient demographics, guarantor and insurance information, posting procedures and insurance/patient payments, scheduling, and ensuring authorizations are current.

General Duties

• Ensure all claims are submitted weekly
• Verifies completeness and accuracy of all claims prior to submission
• Accurately post all insurance and patient payments daily
• Timely follow-up on insurance claim denials
• Reading and interpreting insurance explanation of benefits
• Completion of monthly aging reports to follow-up on unpaid claims aged over 30 days
• Monthly patient statements
• Obtaining referrals/authorizations
• Scheduling of appointments

Competencies

• Leadership and staff motivation skills
• Business Acumen.
• Communication.
• Consultation.
• Critical Evaluation.
• Ethical Practice.
• Global & Cultural Awareness.
• Relationship Management.

Supervisory Responsibility

None

Required Education and Experience

• High school diploma/GED required + 2 years’ experience
• Electronic Medical Record experience 
• Exceptional customer service skills
• Advanced communication and organizational skills 
• Ability to multi-task and work courteously and respectfully with fellow employees, physician offices and patients.

Preferred Education and Experience

• Spanish speaking
• CPT and ICD-10 coding
• Health care terminology highly desired
• Experience in filing claim appeals with insurance companies to ensure maximum entitled reimbursement.
• Knowledge of private insurance and Medicaid referral/authorization guidelines

Additional Eligibility Qualifications

• Must pass criminal history background check

Other Duties - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice. 

Work Environment - Shared office space

Essential Functions - Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.