AR Caller (Physician Billing)

Job Description

Role & responsibilities: Technical Skills: 1. Medical Billing Systems: • Familiarity with popular billing software such as Epic, Cerner, Meditech, NextGen, ClinicalWorks, Modmed, or PHIMed. • Experience with HCFA-1500 forms, UB-04 forms, and other insurance-specific claim forms. 2. Domain Knowledge: • Handle medical billing processes for various insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. • Experience in denials management, including identifying denial reasons, appeals process, and follow-up to resolve denials promptly. • Strong understanding of insurance types, including Medicare, Medicaid, HMO, commercial insurance, and Workers' Compensation. • Proficiency in CPT, ICD-10, and Modifiers to assign correct codes and ensure compliance with coding standards. • Demonstrate a basic understanding of revenue cycle management to optimize billing procedures and revenue generation. • Manage denials effectively by identifying reasons for denials, initiating appeals, and following up to ensure resolution and minimize revenue loss. 3. Claim Submission & Denial Management: • Proficient in claim submission through EDI (Electronic Data Interchange) or other methods. • Experience managing claim denials and rejections, appealing denied claims, and identifying the reason behind denials. • Ability to correct errors in coding or documentation to ensure proper reimbursement. 4. Compliance & Regulations: • Deep understanding of HIPAA regulations to ensure patient confidentiality and compliance. • Awareness of insurance payer guidelines, federal/state regulations, and any updates to medical billing practices. • Knowledge of Medicare/Medicaid billing guidelines and commercial payer contracts Preferred candidate profile: Specify required role expertise, previous job experience, or relevant certifications. Perks and benefits: Mention available facilities and benefits the company is offering with this job.