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Job Description

 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.