SUMMARY: Knowledgeable in Medicare, Medicaid, Worker’s Compensation and Third Party Payer claim processing. Knowledgeable in bookkeeping, computer skills as related to claims processing, possess organizational skills and the ability to work independently.
ESSENTIAL DUTIES AND RESPONSIBILITIES: (as assigned)
- Demonstrates knowledge and ability to follow medical billing practices.
- Demonstrates knowledge of Level I Healthcare Common Procedure Coding Systems (HCPCS) comprised of Current Procedural Terminology (CPT-4) and International Classification of Diseases (ICD) codes.
- Demonstrates knowledge of Medicare, Medicaid, Insurance Managed Care Plans and Workmen’s Compensation.
- Manages Accounts Receivable effectively, reviewing with manager problem claims.
- Reads and monitors bulletins from plans subscribed to for changes and updates in claims submission.
- Follow up phone calls on collections.
- Gives professional customer service to patients and public at all times.
- Maintains any logs necessary for collections and QA purposes.
- Download Medicare receipts on accounts.
- Submits all claims to Medicare, Medicaid, primary insurances, and supplemental/secondary insurances.
- Enter charges for services rendered.
- Re-submits claims as necessary and handles appeals process when necessary.
- Researches and resolves correspondence from insurance carriers or private patients concerning claims.
- Reviews and corrects claim edits and denials to ensure proper payment for services rendered.
- Develops and maintains positive, effective working relationships with other employees, supervisors and medical providers.
- Ensure strict confidentiality of financial and medical records under HIPAA, HIPAA Security laws and hospital/clinic policies and procedures.
- Communicates clearly written and oral medical information to professional practitioners and/or the general public.
- Attends meetings as required.
- Miscellaneous duties as assigned requested or required.
