SUMMARY: Coordinates insurance and billing related activities associated with the care of service provided to the customers of the company.
ESSENTIAL DUTIES AND RESPONSIBILITIES: Reasonable accommodations may be made to enable individuals with disabilities to perform these essential functions.
- Enter charges accurately and expeditiously to ensure proper records handling and fast payment responses.
- Initiate private pay collections after insurance cancellation, denial or other issue.
- Obtaining referrals and pre-authorizations as well as eligibility and verification of benefit when required.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Following up on unpaid claims within standard billing cycle timeframe.
- Checking each insurance payment for accuracy and compliance with contract discount.
- Identifying and billing secondary or tertiary insurances.
- Maintain accuracy of tables as well as inform management with rate changes.
- Check to see if claims remain unpaid and follow up with patients and insurance companies to determine the cause of the delay and to keep the billing cycle on track.
- Look into claims that are denied and research how to modify the claim to ensure it is processed correctly at maximum reimbursement.
- Answer inquiries made by patients, insurance companies, or fellow employees regarding assigned accounts, the billing process or the appeals process. This includes reviewing for accuracy, completeness, and obtaining missing information.
- Maintain complete understanding and knowledge of all reimbursement requirements for assigned payer as well as general knowledge for payers outside of those assigned.
- Communicate policy changes/issues to management so information can be communicated out to other areas of company.
- Liaise between payers/provider representatives when necessary.
- Uphold positive attitude towards tasks and co-workers, as well as a commitment to teamwork throughout the billing team and the organization.
- Serves as troubleshooter for accounts receivable problems and as back-up troubleshooter for complete system.
- Other duties as requested by Management.
