Essential Duties & Responsibilities
- Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providers
- Update patient demographics/insurance information in appropriate systems
- Research/ Status unpaid or denied claims
- Monitor claims for missing information, authorization, and control numbers (ICN//DCN)
- Research EOBs for payments or adjustments to resolve claim
- Contacts payers via phone or written correspondence to secure payment of claims; reconsideration and appeal submission.
- Access client systems for payment, patient, claim and data info
- Follows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systems
- Secure needed medical documentation required or requested by third party insurance carriers
- Maintain and respect the confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Perform other related duties as required
Minimum Requirements & Competencies
- 3+ years of medical collections, denials and appeals experience
- Must have at least 6 months of EPIC tool experience.
- Experience with all but not limited to the following denials- DRG downgrades, level of care, coding, medical necessity
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Intermediate knowledge of third-party billing guidelines
- Intermediate knowledge of billing claim forms (UB04/1500)
- Intermediate knowledge of payor contracts- commercial and government
- Intermediate Working Knowledge of Microsoft Word and Excel
- Intermediate knowledge of health information systems (i.e. EMR, Claim Scrubbers, Patient Accounting Systems, etc.)
Preferred Requirements & Competencies
- Intermediate knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
- Intermediate of DDE Medicare claim system
- Intermediate Knowledge of government rules and regulations
- Must be willing to work onsite in Ortigas, Pasig City.
