Responsible for two aspects of billing, collection, credit, payments, and/or reconciliations. Billing responsibilities include manual re-bills as well as electronic submission to payers. Follow-up includes telephone calls to payers and/or patients, as well as accessing payer websites, and resolving complex accounts with minimal or no assistance necessary.

Billing
* Demonstrates knowledge of editing and submitting claims to insurance clearing house by electronic or paper submission.

* Demonstrates knowledge of when to send a claim to the auditor or coder for corrections.

* Reviews and make corrections to rejected claims and resubmits to payers.

* Open communication on Updates-CPT codes and ICD-10 codes, as needed. Works with Billing Manager to maximize revenue potential based for services and providers.

 
Claim follow up
* Corrects, edits and manages denied claims through work queues, correspondence and emails: May consist of Invalid CPT, Invalid DX, Missing Modifier, Bill another Carrier, Invalid Eligibility, Authorization/Referral, Documentation Required or Other open tasks requiring intervention.

* Enters encounter notes, regarding rejections and follow up activities performed to enable others to review claim history on all encounters.

* Performs account adjustments or write-offs as needed in accordance with the 'Write-Off' policy.

* Handles internal communications with the health centers related to insurance billing and collections.

* Requests medical records from health centers as requested by the contracted insurance plans.

* Corresponds with and assists vendors involved with patient accounts.

 
Compliance/Safety
* Responsible for reporting any safety related incident in a timely fashion through the Midas/RDE tool; attends all safety related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner.

* Maintains confidentiality of all department, patient, and billing matters.

* Completes all company mandatory modules and required job specific training in the specified time frame.

* Stays current and complies with state and federal regulations/statutes and company policies that impact the employees area of responsibility

Education
High School Diploma or GED- Required

Certification & Licensures

Experience
Medical Insurance Billing/Collections- Preferred

Medical/Hospital Billing- Preferred

Knowledge UB04- Preferred

Knowledge of Explanation of Benefits (EOB)- Preferred

Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.