Job
Description
Role Overview: You will be responsible for working through the book of AR and developing a plan for maintaining proper coverage on all accounts. This includes reviewing aged accounts, tracing, and appealing unpaid and/or erroneously paid or denied accounts. Your role will involve working all denials and rejections, researching steps previously taken, and taking additional action as needed to resolve the claim. Additionally, you will review and correct claim rejections received from the clearinghouse, verify eligibility, coverage, and claim status online through insurance web portals, and resubmit insurance claims that have received no response or are not on file. It is crucial to transfer outstanding balances to the patient or the next responsible party whenever required. Other essential tasks include making corrections on CMS 1500 claim forms, rebilling claims, and working on Commercial, Medicaid, Tricare, and Workers Compensation denials/rejections. Properly documenting insurance denials/rejections and communicating claim denials/rejections details related to missing information with the client are also part of your responsibilities. You will collaborate with other staff to follow up on accounts until a zero balance is achieved, maintain required billing records, reports, and files, review and address correspondence daily, identify trends, and inform the client lead/manager as appropriate. Escalating issues to the client lead/manager when necessary and performing any other responsibilities as assigned complete your duties. Key Responsibilities: - Develop a plan for maintaining proper coverage on all accounts - Review aged accounts, trace, and appeal unpaid and/or erroneously paid or denied accounts - Work all denials and rejections by researching steps previously taken and taking additional action as needed - Review and correct claim rejections received from the clearinghouse - Verify eligibility, coverage, and claim status online through insurance web portals - Resubmit insurance claims that have received no response or are not on file - Transfer outstanding balances to the patient or the next responsible party whenever required - Make corrections on CMS 1500 claim forms, rebill claims, and work on Commercial, Medicaid, Tricare, and Workers Compensation denials/rejections - Properly document insurance denials/rejections and communicate claim denials/rejections details related to missing information with the client - Collaborate with other staff to follow up on accounts until a zero balance is achieved - Maintain required billing records, reports, and files - Review and address correspondence daily - Identify trends and inform the client lead/manager as appropriate - Escalate issues to the client lead/manager when necessary - Perform any other responsibilities as assigned Qualification Required: - Minimum of one year's experience working with a healthcare provider or an Associates Degree in Healthcare Management, Business Management, or a related field - Experience with healthcare billing and collections - Experience with various practice management systems such as Advantx, HST, Vision, Amkai, SIS, Cerner, CPSI, Meditech, CEntricity, Allscripts, AdvancedMD - Experience with revenue cycle management and follow-up - Experience with facility and/or professional revenue cycle experience - Proficient with MS Outlook, Word, and Excel - Ability to work independently and as part of a team - Strong attention to detail and speed while working within tight deadlines - Exceptional ability to follow oral and written instructions - A high degree of flexibility and professionalism - Excellent organizational skills - Ability to work in a fast-paced environment - Outstanding communication skills; both verbal and written - Positive role model for other staff and patients by promoting teamwork and cooperation - Ability to apply common sense understanding and logic in day-to-day activities,
