- Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
- Review and prepare claims for manual and/or electronic billing submission.
- Reviews insurance rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding rejections.
- Correct and identify billing errors and resubmit claims to insurance carriers.
- Update CAS segments on secondary electronic claims as needed.
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
- Verifies receipt of claim with insurance plans, determining the next appropriate action step.
- Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients.
- Obtains and attaches referrals to appointments/charges.
- Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
- Identifies and communicates trends and/or potential issues to the management team.
- Follows and maintains all HOPCo policies and procedures.
- Other duties as assigned.
EDUCATION
- High school diploma/GED or equivalent working knowledge preferred.
EXPERIENCE
- Minimum of two to three years of experience in medical billing.
- Prior experience working on claim errors in a claims management system preferred.
- Must have strong knowledge of resolution to payor edit reports, and reconciliation of clearinghouse and payor acceptance reports.
- Candidates with knowledge of ANSI formatting preferred.
KNOWLEDGE
- Knowledge of ICD-9, ICD-10, HCPS, and CPT coding, medical terminology, Medicare reimbursement guidelines, billing practices.
- Knowledge of government regulatory requirements and commercial contracts.
- Advanced computer knowledge, including Window based programs.
SKILLS
- Skill in providing excellent customer service.
- Skill in using computer programs and applications.
- Skill in establishing good working relationships with both internal and external customers.
ABILITIES
- Ability to multi-task in a fast-paced environment.
- Must be detailed oriented with strong organizational skills.
- Ability to understand patient demographic information and determine insurance eligibility.
- Ability to work independently and demonstrate the ability to analyze data.
ENVIRONMENTAL WORKING CONDITIONS
- Normal office environment.
- Extended work hours at or near month end to meet department objectives may be necessary.