Essential Job Functions:
- Responsible for performing claim research and follow-up work with insurance companies to resolve accounts which have been billed but remain unresolved.
- Reviewing notes on client systems to see what work has already been performed.
- Determining next steps by either calling the insurance company or using electronic tools to determine claim status.
- If no claim is on file, it will need to be re-billed through the client's systems.
- If a claim is rejected, find out why and decide if it can be re-billed with proper information, if it should be patient responsibility, or if it is a timely filing issue.
- If coding needs to be changed, submit to appropriate group for review.
- Work specific payers and accounts as assigned by management.
- Responsible for submitting accounts to be written off or changed to patient responsibility.
- Responsible for claim denials and determining how to resolve the claim either by correction, re-billing, or if it was rejected authorization issues.
- Providing weekly reports on claims worked, re-billed, and submitted for write-off.
- Responsible for working from multiple computer systems simultaneously and learning them quickly.
- Following all Federal and State guidelines concerning the proper handling of medical receivables.
- All other duties as assigned by management.
Knowledge, Skills and Abilities:
- Employee must be comfortable with the following:
- Microsoft Windows operating systems (Windows XP, Vista, & 7)
- Microsoft Office Productivity Suite (Word, Excel, and Outlook version 2007)
- Be able to learn multiple separate client computer systems
- Oral and written English language skills
- Must be able to Electronic File
- Make Billing Corrections
- Be comfortable talking to others over the phone for extended time periods
- Being assertive with insurance companies to resolve issues
- Demonstrate very strong billing and follow-up skills
- Be able to work in an environment that promotes positive customer service practices
- Be able to work independently, multi-task, and follow instructions
- Thorough knowledge of medical terminology EOB’s, DRG’s HCPCS’s, CPT & ICD codes, etc.)
- Thorough knowledge of UB04 forms
- Working knowledge of medical billing systems and normal healthcare billing workflows.
Education and Experience:
- Minimum of 3 years experience in a hospital / physician business office performing billing and claim follow-up work with direct hospital billing experience being preferred.
- Experience with at least one of these payer types is required, with multiple being preferred:
- Medicare, Medicaid (Promise), Managed Care, Blue Cross (Navinet), or Commercials.
- Educational requirements:
- Applicant must possess a high school diploma or GED
- In addition, technical schooling in medical billing/coding and/or a college degree in a related field is preferred
Pay rate: $15/Hr.