Pay will be determined based on experience, skills, and qualifications
General Summary of the Job:
This position is responsible for collecting payments from insurance companies ensuring that company receives correct payments for the medical services rendered. The position is a Full-Time Non-Exempt position.
Essential Job Functions:
- Investigate rejected/underpaid claims; resolve issue(s) and resubmit claims
- Prepare appeal letters to insurance carrier when not in agreement with claim denial
- Create insurance aging report using the medical practice billing software; these reports are used to identify unpaid insurance claims
- Understanding of EOB payment posting on insurance and patient payments
- Understanding of HMO, PPO Networks, Medicare, Medicaid, Worker Compensation and other third-party carriers
- Share knowledge by communicating with clinical staff regarding updated insurance policies and guidelines
- Perform other related duties and special projects as assigned
Expectations
- Maintain confidentiality; adhere to all HIPAA guidelines/regulations
- Prioritize tasks by level of importance to meet deadlines
- Work cooperatively in a team atmosphere
- Maintain workflow and follow company’s policies and procedures
- Participate in professional development activities to keep current with healthcare trends and attend weekly staff meeting
Education and Experience
- High School Diploma required
- Basic computer skills required
- Minimum of two years of experience working in a healthcare billing and/or collections department required.
- Experience in orthopaedic field is preferred
Performance Requirements:
Knowledge:
- Understanding of full billing and collections cycle.
- Understanding of EOB payment posting, HMO, PPO Networks, Medicare, Medicaid, Worker Compensation and other third-party carriers.
- Understanding of medical practice systems.
- Knowledge of coding classification including CPT, ICD-10-CM, HCPCS.
- Knowledge of medical billing, collections, and appeals process
Skills:
- Great verbal and written communication skills
- Analyzing, planning, organizing, and prioritizing.
- Cooperation – being a team player.
- Problem solving; taking initiative and making sound judgment independently
Abilities:
- Ability to read and interpret medical billing code
- Ability to set priorities among multiple requests
- Ability to interact easily and effectively with others
Equipment Operated
- Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.
Work Environment
- Position may be in either a well-lighted office or home environment. Mental/Physical Requirements
- Involves sitting approximately 90 percent of the day, walking or standing the remainder.
