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
Qualifications:
- 2+ years of medical collections/billing experience
- At least 6 months direct experience working in Epic’s billing modules (Epic Resolute PB or Epic Resolute HB)
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Expert knowledge of third party guidelines
- Expert knowledge of billing claims forms (UB04/1500)
- Expert knowledge of payor contracts
- Working Knowledge of Microsoft Word and Excel
- Intermediate working knowledge of health information systems(i.e, EMR, Claims Scrubbers, Patient Accounting Systems, etc.)
- Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts, or Paragon
- Working knowledge of DDE Medicare claim system
- Knowledge of government rules and regulations
- Must be willing to work onsite.
