SUMMARY: Requires knowledge of ICD-10 coding, accurate typing skills, computer knowledge, prior utilization of an Electronic Medical Record system, knowledge of medical terminology, and the ability to communicate effectively with physicians, co-workers, insurance plan representatives and attorneys.

DUTIES AND RESPONSIBILITIES:

• Identify billing errors for corrections and resubmit claims to insurance carriers.
• Follow up on payment errors, low reimbursement, and denials.
• Compile, code, and submit patient insurance claims to insurance companies as well as follow up on all claims from charge entry through resolution.
• Review insurance EOB’s and initiate appeals as necessary.
• Respond and appeal to medical necessity denials.
• Updating system errors, noting system, researching insurance guidelines.
• Follow protocol to determine best course of action to follow up on open receivables.
• Research root issue of denial. Apply knowledge of payer policies to pursue proper course of appeal or follow up to obtain payment.
• Review account history for continuous follow up.
• Contact insurance companies and/or patient/guarantor through phone contact, correspondence, online portals and other approved means to obtain status of outstanding claims and submitted appeals.
• Documents clearly in billing system the claim issue and course of action taken on every account worked. Documentation and action must be clearly noted for future follow up and review.
• Escalate issues and problems to supervisor as appropriate.
• Identify trends or patters of persistent problems.
• Perform charge corrections based on payer and institutional policies.
• Negotiate out-of-network reimbursement, based on determined criteria for max reimbursement.
• Perform other related duties as assigned by management.

QUALIFICATIONS:

• High school diploma or equivalent.
• Medical Coding Certification.
• Three to five years experience with ICD-10, insurance collections and processing out-of-network claims.
• Excellent written and oral communication skills.
• 10-key by touch; keyboarding speed of at least 50 wpm.
• Knowledge of medical billing terminology.
• Ability to perform diversified clerical functions and basic accounting procedures.
• Ability to effectively communicate with people at all levels and from various backgrounds.
• Commitment to excellence and high standards.
• Strong organizational, problem-solving, and analytical skills.
• Ability to manage priorities and workflow.
• Versatility, flexibility, and a willingness to work within constantly changing priorities with enthusiasm.
• Acute attention to detail.
• Ability to work independently and as a member of various teams and committees.
• Excellent customer service skills
• Proven ability to handle multiple projects and meet deadlines
• Bilingual skills a plus.
• Ability to understand and follow written and verbal instructions.