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About the Role
Manage outstanding insurance accounts through written or verbal direction from insurance carriers for accurate and timely claim filing, maximum reimbursement, and posting rejections with accurate explanations. Address patient balance inquiries and provide outstanding customer service.
Responsibilities
- Thoroughly research reasons for denied claims and work appeals to resolve outstanding balances.
- Resolve denials/appeals in the Hold bucket within 72 hours of receipt.
- Review previously worked claims within a minimum of 30 days.
- Accurately and timely resolve professional billing claim and clearinghouse edits, as well as payer rejections.
- Resolve claims that are greater than 60 days from the date of service.
- Work a minimum of 50 claims per day.
- Communicate effectively with Coders to handle the accurate and timely resolution of coding-related claim edits and appeals.
- Identify and document new payer denial trends, and notify supervisor for escalated follow-up.
- Manage patient and payer credit balances with established policy and procedures.
- Answer phone calls regarding billing inquiries and resolve billing issues politely and confidently.
- Create collections work lists and submit for provider approval.
- Assist with charge entry backlog.
- Maintain regular and prompt attendance.
- Exhibit ethical conduct, confidentiality, and collaboration with the healthcare team.
- Perform other duties as assigned.
- Maintain physical demands and work environment requirements.
Requirements
- Minimum of 3 years of experience in revenue cycle management.
- Good understanding of Medicaid, Medicare, and Commercial Insurance.
- Practice management software experience.
- Familiarity with CPT and ICD 10 coding.
- Familiarity with medical terminology.
Skills
- Customer service
- Claim filing
- Reimbursement
- Denial posting
- Appeals
- Billing inquiries
- Collections
- Charge entry
- Coding
- Medical terminology
- Revenue cycle management
Location
- Hybrid
Work Type
- Full-time
- Hybrid
Experience Level
- 3 years
Education Level
- High School Diploma or equivalent
- Some college preferred