Billing Claims Specialist, Accounts Receivable

The Billing Claims Specialist, Accounts Receivable plays a critical role in integrating billing and revenue best practices in response to payor adjudication for the contracted, non-contracted, government payor groups. This position focuses on claims processing, accounts receivable management, and handling low pay claims, denials, expect to pay discrepancies, appeals, and other various tasks related to accounts receivables. The successful candidate will ensure accurate billing, timely reimbursement, and compliance with industry standards.

Essential Functions

• Answer and direct phone calls.
• Research and appeal denials in a timely manner
• Keep desk current as time frame deemed appropriate by manager, reach daily KPIs.
• Complete designated Error Processing and reject reports in a timely manner.
• Correspond with patients and insurance companies
• Process all denials, rejections, priority HMO's, and insurance with short timely filing limits
• File appeals and contact payers to fruition
• All other duties as assigned

Job Requirements and Skills

• 3+ years of medical billing experience (Pathology billing experience is a plus)
• High school diploma
• Advance knowledge of PPO, HMO, IPA, CMS, Managed Medi-caid/Managed Medicare
• Working knowledge of CPT/ICD Codes
• Knowledge of eligibility and benefits
• Detail-oriented and ability to demonstrate a positive and proactive attitude
• Ability to work cooperatively with others in a team environment
• Self-starter with solid organizational skills and ability to effectively manage multiple priorities or reprioritization of projects
• Excellent written and verbal communication skills
• Documentation skills, ability to research and resolve issues
• Ability to multi-task with a results-oriented paradigm in a fast-pace, high volume environment
• Ability to read and interpret EOB's
• Proficient in Microsoft Office Suite - Strong Excel and Word skills are required