JOB SUMMARY: This position is responsible for the timely submission and follow-up of technical or professional Medicare claims to insurance companies.
ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES:
- Claim follow-up of assigned insurance companies for CEC and CESC
- Generate reports to identify claim errors prior to claim filing
- Perform audit functions as needed
- Reports to run and work
- Medicare Claims
- Medicare Advantage Claims
- DME Claims (Medicare Glasses)
- Contact patients, when necessary, to obtain necessary information for accurate claim processing.
- Communicate with physicians and lead technicians to ensure accurate claim processing
- Identify any patterns of denials and report to Billing Supervisor
- Properly notate accounts with information related to claim follow-up status
- Correct rejected claims in clearinghouse system.
- Handles the injection assistance programs by working the outstanding A/R, post payments, and recertify patients yearly.
- Participate in answering patient phone call rotation
- Explain charges and/or balances
- Obtain and process patient payments
- Send patient requested information
- Collect DMV payments and email appropriate physician
- Must comply with all HIPPA and safety policies, procedures, and regulations.
- This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. To meet the business needs of the company duties, responsibilities, and activities may change at any time with or without notice.
EDUCATION AND EXPERIENCE:
- High school diploma or equivalent and 1 to 2 years previous experience required.
KNOWLEDGE, Skills, and Abilities:
- Proficient in Microsoft Office applications
- Knowledge basic accounting principles
- Strong attention to detail with a dedication to accuracy
- Excellent verbal and written communication skills
- Excellent customer service skills
- Familiarity with accounts receivable functions
- Ability to work independently and as part of a team
- Knowledge of NextGen preferred
WORKING CONDITIONS AND PHYSICAL EFFORT:
- Full-time position with a work schedule of Monday through Friday 8:00am to 5:00pm.
- Position operates in a professional office environment requiring minimal physical activity.
- Building meets required ADA standards and we will make reasonable accommodations to enable individuals with disabilities to perform the essential functions of the job.
- Physical demands include but are not limited to:
- The ability to sit, stand, walk, and use hands and fingers to operate a computer keyboard, mouse, and telephone to talk and hear.
- The ability to frequently sit and reach with hands and arms.
- The ability to occasionally lift and/or move up to 25 pounds.
- Must be able to utilize office equipment such as desktop/laptop computers, copiers, printers, scanners, telephones and calculators.
