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 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 confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedure
- Perform other related duties as required
- Utilize provider billing manuals to obtain billing guidelines and requirements.
- Write appeal letters for technical appeals
- Verifies accuracy of underpayments utilizing contracts and claims data.
- Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denials
- Utilizes reports for analysis and to monitor follow up activities and prioritization
- Assists organization with working through special projects as needed
- SME for colleagues and provide direction for resolution of accounts
- Assists in new hire training
- Assists in content building of training materials
Qualifications & Competencies
- 3+ years of medical collections/billing experience
- 2+ years of experience as a Team Leader
- Intermediate knowledge of ICD-10, CPT, HCPCS and NCCI
- Expert knowledge of third-party billing guidelines
- Expert knowledge of billing claim 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, Claim Scrubbers, Patient Accounting Systems, etc.)
- Must be willing to work onsite.
Preferred Qualifications
- Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or Paragon
- Prior team lead experience
- Working knowledge of DDE Medicare claim system
- Knowledge of government rules and regulations
