JOB PURPOSE : Position is responsible for researching and resolving outstanding claims issues to ensure maximization of claims reimbursement.

JOB QUALIFICATION REQUIREMENTS :

Education :

High school education or equivalent, with specialized training in Medical billing

Experience :

• Two years experience of Medical Insurance Collections / Follow up
• Two years experience using a computerized accounts receivable system in a medical or hospital environment performing billing functions.
• Knowledge of current ICD-10 coding in a medical or hospital setting.
• Experience handling confidential data i.e., patient demographic information, payor fee schedules, reimbursement rates, etc.

PERFORMANCE REQUIREMENTS :

Knowledge :

• Knowledge of current CPT-4 and ICD-10 coding.
• Knowledge of common insurance plans, i.e., HMO, PPO, Medicare and Medi-cal

Skills :

Proficient skills in computer programs.

Abilities :

• Ability to understand and interpret policies and procedures.
• Ability to communicate effectively and work with others.
• Ability to apply principles of analytical thinking to extract correct data from documentation.

JOB FUNCTIONS :

• Monitor all payer types on unresolved claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner
• Identify coding or billing problems from EOBs and work to correct the errors in a timely manner
• Identify problem accounts and escalate as appropriate
• Identify trends and make suggestions on process improvements
• Update the patient account record to identify actions taken on the account
• Work on multiple Practice Management systems
• Work with patients and guarantors to secure payment on outstanding account balances
• Sort and file correspondence
• Initiate appeals for denied claims as appropriate
• Enter detailed notes to provide an audit trail for future follow up
• Work error reports in a timely manner (set by Director / Manager)
• Meet with assigned Providers as needed.
• Meet with insurance carriers as issues are identified

Experience :

• computerized accounts receivable system : 2 years (preferred)
• Medical Insurance Collections / Follow up : 2 years (preferred)

Compensation / Pay Rate (Up to) : $18.00 - $21.00 Per