Job Description

• Maintains productivity and accuracy metrics per department expectations.
• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Assist in identifies and communicating trends and/or potential issues to management team.
• Payer website user access maintenance.
• Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
• Responsible for EDI, ERA and EFT enrollments for all payers.

EDUCATION

• High school diploma or GED

EXPERIENCE

• Minimum two to three years of experience in medical billing. Experienced candidates will have prior experience working claim errors in a claims management system. Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.

REQUIREMENTS

• Requires demonstrated knowledge of revenue cycle applications. Prefer prior experience configuring revenue cycle vendor-supplied software.

KNOWLEDGE

• Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
• Advanced computer knowledge, including Window based programs.