Pay will be determined based on experience, skills, and qualifications
General Summary of the Job:
This position is responsible for collecting payments from insurance companies ensuring that company receives correct payments for the medical services rendered. The position is a Full-Time Non-Exempt position.
Essential Job Functions:
• Investigate rejected/underpaid claims; resolve issue(s) and resubmit claims
• Prepare appeal letters to insurance carrier when not in agreement with claim denial
• Create insurance aging report using the medical practice billing software; these reports are used to identify unpaid insurance claims
• Understanding of EOB payment posting on insurance and patient payments
• Understanding of HMO, PPO Networks, Medicare, Medicaid, Worker Compensation and other third-party carriers
• Share knowledge by communicating with clinical staff regarding updated insurance policies and guidelines
• Perform other related duties and special projects as assigned
Expectations
• Maintain confidentiality; adhere to all HIPAA guidelines/regulations
• Prioritize tasks by level of importance to meet deadlines
• Work cooperatively in a team atmosphere
• Maintain workflow and follow company’s policies and procedures
• Participate in professional development activities to keep current with healthcare trends and attend weekly staff meeting
Education and Experience
• High School Diploma required
• Basic computer skills required
• Minimum of two years of experience working in a healthcare billing and/or collections department required.
• Experience in orthopaedic field is preferred
Performance Requirements:
Knowledge:
• Understanding of full billing and collections cycle.
• Understanding of EOB payment posting, HMO, PPO Networks, Medicare, Medicaid, Worker Compensation and other third-party carriers.
• Understanding of medical practice systems.
• Knowledge of coding classification including CPT, ICD-10-CM, HCPCS.
• Knowledge of medical billing, collections, and appeals process
Skills:
• Great verbal and written communication skills
• Analyzing, planning, organizing, and prioritizing.
• Cooperation – being a team player.
• Problem solving; taking initiative and making sound judgment independently
Abilities:
• Ability to read and interpret medical billing code
• Ability to set priorities among multiple requests
• Ability to interact easily and effectively with others
Equipment Operated
• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.
Work Environment
• Position may be in either a well-lighted office or home environment. Mental/Physical Requirements
• Involves sitting approximately 90 percent of the day, walking or standing the remainder.