Job description
We are seeking an experienced Medical Billing - Revenue Cycle Management specialist to join our medical billing team. The ideal candidate will have a strong understanding of medical billing processes and terminology, experience in follow-up for Out-Of-Network providers, ensuring accurate and timely follow-up on billed claims.
Roles & Responsibilities:
- Responsible for claims follow -up, Professional and Facility, from claim submission until final payment
- Communicate with insurance companies regarding claim denials or underpayments
- Utilize Payer Online Portals such as Availity, Cignaforhcp, UHC, Navinet, Emblem for claims status and eligibility verification
- Send Medical Records to payers, filing reconsiderations and appeals
- Utilize providers EMR’s to obtain Medical Records
- Reading and understanding various payers EOB’s
- Posting payments, writing off balances and sending statements to patients, when necessary
- Communicating with 3rd party payers such as Multiplan, MARS and Zelis regarding OON claim negotiations.
- Follow up on Pre-negotiated Agreements a/k/a Single Case Agreements
- Review and verify accuracy of billing data utilizing Optum EncoderPro
- Utilize medical collection systems to track and collect payments
- Ensure compliance with all relevant coding and billing regulations
- Effectively resolve complex issues, including payment research, payment recoupments
- Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions
Experience & Requirements:
- Knowledge in Multi-Specialty coding - CPT and ICD codes for many different specialties
- Experience working with medical billing software like Imagine and ADS
- Familiar with Gap (Network Deficiency) exception and prior authorizations process
- Familiar with Federal IDR arbitrations process
- Familiar with OON Provider Registration Process with various Payers
- Knowledge of medical terminology (Hicfa, UB04, Tax ID, NPI)
- Strong attention to detail and persuasive telephone skills
- Excellent communication and interpersonal skills
- Solid skill with Microsoft Office applications: Word, Excel, Teams, Power BI reporting, Zendesk
- High School Diploma or equivalent
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Work Location: In person
Job Type: Full-time
Pay range: $60,000 - $70,000 (annual Salary is Commensurate with Experience)
Ability to Commute:
- Boca Raton, FL 33433 (Required)
Ability to Relocate:
- Boca Raton, FL 33433 - Relocate before starting work (Required)
Job Type: Full-time
Pay: $60,000.00 - $70,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Vision insurance
Ability to Commute:
- Boca Raton, FL 33433 (Required)
Ability to Relocate:
- Boca Raton, FL 33433: Relocate before starting work (Required)
Work Location: In person
