Job Description

Summary:

Responsible for insurance claim submission, follow up, and resolution for commercial, Medicare, Medicaid, and patient accounts. Responsible for all patient account collection efforts, including, but not limited to, generating patient statements, making payment arrangements, collecting on accounts, monitoring and pursuing delinquent accounts. Ensures billing practices that are prompt, ethical, and compliant with organizational, payer, and governmental regulations and guidelines.

Duties and Responsibilities:

• Submit claims and follow up with insurance payer on unpaid, rejected, or denied claims.

• Correct and resubmit claims as necessary.

• Collect and enter claim information as necessary.

• Ensure claim information is complete and accurate.

• Submits insurance claims to payer electronically or via paper.

• Prepares and submits appeal letters to payer when not in agreement with claim denial. 

• Prepare and submit secondary and tertiary claims as needed.

• Assess aged accounts to establish adjustment recommendations.

• Post insurance and patient payments using medical billing software.

• Assist internal staff in answering questions pertaining to billing.

• Create and monitor aging reports to ensure timely follow up and resolution.

• Ability to analyze claims in order to identify trends. 

• Prepare patient refund requests for approval by Revenue Cycle Director. 

• Establish and maintain payment plans for patient accounts. 

• Collect on delinquent patient accounts through phone and mail correspondence. 

• Assist internal staff in answering questions pertaining to billing. 

• Assist Revenue Cycle Director to resolve claim/billing issues as needed. 

• Maintain up-to-date procedure manual.

• Works with Information Technology (IT) and Revenue Cycle Director to resolve electronic health record (EHR) technical issues related to billing.

• Maintains confidentiality of information at all times. Process pre-authorization requests for specialty services as needed. 

• Adheres to professional standards, organizational policies and procedures, federal, state, and local requirements; and Joint Commission standards.

• May perform other duties as assigned. 

Qualifications and Skills:

• Two (2) to five (5) years of previous medical billing and/or outpatient claims experience preferred.

• Certificate in Medical Billing/Coding and/or Associate’s Degree in Health Information Management, Business, or related field preferred. 

• CCA, CCS, CCS-P, RHIT, RHIA, CPC, COC, and/or CPB credentials preferred. 

• Proficiency in ICD-10 and CPT medical billing codes. 

• Bilingual English/Spanish is a plus, but not required

• Extensive knowledge of insurance claim submission and reimbursement processes.

• Extensive knowledge of Medicare and Medicaid billing protocol. 

• Excellent skills in time management, cognitive reasoning, workflow solutions, etc.

• Excellent skills in Math, English usage, grammar, punctuation and style.

• Excellent written and verbal communication skills.

• Highly organized and detailed oriented.

• Know

Medical Billing, Coding or Associates Degree in Health Information Management

Minimum 2 years previous medical billing or outpatient claims experience.

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