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Responsibilities
- Submit insurance claims manually, via fax, and insurance portals.
- Contact insurance carriers and follow up on outstanding claims.
- Identify, complete, and resolve insurance denials promptly.
- Appeal insurance claims when required.
- Provide excellent customer service when following up on outstanding claims.
- Generate daily, weekly, and monthly reports including Dept Overview, Productivity Reports, Posting Review Schedule, and Insurance Negotiations/Settlements.
- Identify insurance trends negatively impacting cash collections and escalate issues as needed.
- Complete department projects as assigned.
- Provide general administrative and clerical support, including mail sorting, record maintenance, faxing, copying, and scanning.
- Collaborate with department managers/supervisors to improve processes and meet department goals.
Requirements
- Knowledge of insurance EOB's layout/language and requirements for various insurance carriers.
- Review and research data, using intuition and experience to complement data.
- Thorough knowledge of transport documentation (PCRs).
- Ability to follow up on outstanding insurance claims.
- Ability to submit appeals and overpayment requests.
- Understanding of Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance.
- Knowledge of credit & collections procedures, and payment plan/settlements.
- Experience in customer service/client relations.
Skills
- ICD-10, CPT and HCPCS coding
- NPI
- HIPAA
- Modifiers
- EPCR’s
- Direct billing
- 3rd party billing
- HMO billing
- Private pay billing
- No-fault billing
- Worker’s compensation billing
- Medicare billing
- Medicaid billing
- Organizational skills
- Multitasking
- Written communication skills
- Verbal communication skills
- Documentation skills (promptness, accuracy, thoroughness, and legibility)
- EMS systems knowledge (preferred)
- Private ambulance knowledge (preferred)
- Medical transportation systems knowledge (preferred)
- Waystar/Clearinghouse knowledge
- Microsoft Word
- Microsoft Excel
- Microsoft Windows
- Medical terminology familiarity
- Detail-oriented
Work Type
- Standard office environment
Education Level
- High school diploma
- Associate degree preferred
- Ambulance/medical billing certification or diploma preferred