Under general supervision, responsible for performing any combination of routine calculating, posting and verifying duties to obtain primary insurance data for use in preparing statements to patients' insurance carriers. May prepare notices to patients of amount expected (or received) from insurance and amount expected from patient.
Responsibilities
- Reviews claims that have been adjudicated by Medicare, Medicaid, and Commercial carriers for appropriate billing.
- Addresses denied claims, claims pended for medical necessity, and claims pending for supporting documentation and/or medical records by working with various teams such as clinic staff, registration staff, and coding staff to complete appeals.
- Extracts information regarding patient treatment from medical records and works closely with coding staff to compose individualized appeal letters.
- Identifies payor specific patterns or trends regarding denials and reports to management for communication to Medical Departments and Administrators.
- Makes the necessary recommendations regarding billing and edit creation to reduce denials.
- Remains current in all payor specific guidelines.
- Utilizes various collection processes such as appeals or collection notices by mail, electronic correspondence, and telephone communication with payor representatives.
- Performs all other duties as assigned.
Qualifications
- Detail oriented with the ability to organize, prioritize and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
- Ability to monitor important and complex projects concurrently.
- Knowledge of Microsoft Word, Excel, PowerPoint, and Lotus Notes/other email software.
- Ability to effectively communicate orally and in writing, to provide excellent customer service, to include writing and preparing memorandums, letters, and other official correspondence.