Job Description

Job Summary:

This position's primary responsibility is to manage the process of reviewing, following up effectively and efficiently on, correcting and/or appealing any unpaid or rejected claims for different insurance carriers. This position will also be responsible to work patient and insurance credit balances and all incoming correspondence related to refund requests.

This position is an in-office, role.

Key Responsibilities:

1. Provide effective and timely resolution of claim denials and aged outstanding claims to obtain maximum reimbursement and avoid timely filing adjustments.

2. Construct effective appeals for denied claims based on the understanding of the denial and appeal process established by the insurance company.

3. Exhibit high level of interest and application of billing processes and policies established by insurance companies, specifically BCBS, Medicaid, Workers Comp, and all state and federal payer sources.

4. Ability to read the details of a patient's account including charges, payments, and credits as well as coordination of benefits when the patient has more than one payer source.

5. Manage billing queue phone calls, including processing patient payments, professionally answer statement questions, and counsel patients on financial obligations.

6. Work an account with a credit balance and can identify when to send a refund to the patient or the insurance company.

7. Identify when refund issues are a posting error or COB issue

8. Generate and submit claims and work electronic denials.

Required Qualifications

:

1. High School Diploma or Graduation Equivalency Degree (GED).

2. Candidates should be familiar with medical terminology and healthcare privacy laws (HIPAA).

3. Minimum one-year related experience in billing, clinical experience is preferred. Completion of certificate in medical billing and coding is preferred.

4. Intermediate knowledge of CPT, HCPS, ICD-10 and how they relate to processing claims

5. Knowledge of working with electronic claims and an EDI clearinghouse.

6. Experience communicating via phone and through internet portals with insurance companies is required.

7. Knowledge of working with electronic claims and an EDI clearing house.

8. Knowledge of basic insurance contracts and allowable

9. Understanding of basic medical and insurance terminology.

10. Regular and timely attendance required to fulfill the urgency of the role.

Skills:

1. Must be highly skilled in customer service, problem solving, prioritization, and strategic thinking.

2. Previous experience with calling insurance companies and effective communication

3. Follows department protocol and works well in a team environment to maximize success as a department.

4. Represent your department in a professional manner to other staff, providers, and patients.

5. Sense of urgency and commitment to timely completion of tasks.

6. Attention to detail along with a commitment to quality.

7. Must be organized and be able to job-share effectively with department counterpart.

8. Must have a positive attitude; be dependable, empathetic, and professional with patients.

9. Must have focus and the ability to multi-task between answering phones, helping patients, and completing tasks.

10. Proficiency with basic computer programs including but not limited to Microsoft Office Suite.

11. Ability to communicate in both written and verbal format effectively and professionally.

12. Must have timely and punctual attendance.

13. All employees have the responsibility to comply with the organizational policies, procedures, code of conduct, and pertinent governmental regulations, and licensing regulations related to the position.

Physical demands:

Sedentary position, up to 8 hours of sitting a day

Visual and finger dexterity required

Must be able to lift to 30 pounds, occasionally

Overtime or irregular hours may be required

Occasional bending and stooping

Must be able to climb 20 stairs

Job Type: Full-time

Pay: $18.00 - $22.00 per hour

Expected hours: 40 per week

Benefits:

401(k) 401(k) matching Dental insurance Employee assistance program Employee discount Flexible schedule Flexible spending account Health insurance Health savings account Life insurance Paid time off Vision insurance
Work Location: In person