Job Description

• Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Review and prepare claims for manual and/or electronic billing submission.
• Reviews insurance rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Update CAS segments on secondary electronic claims as needed.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Verifies receipt of claim with insurance plans, determining the next appropriate action step.
• Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients.
• Obtains and attaches referrals to appointments/charges.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
• Identifies and communicates trends and/or potential issues to the management team.
• Follows and maintains all HOPCo policies and procedures.
• Other duties as assigned.

EDUCATION

• High school diploma/GED or equivalent working knowledge preferred.

EXPERIENCE

• Minimum of two to three years of experience in medical billing.
• Prior experience working on claim errors in a claims management system preferred.
• Must have strong knowledge of resolution to payor edit reports, and reconciliation of clearinghouse and payor acceptance reports.
• Candidates with knowledge of ANSI formatting preferred.

KNOWLEDGE

• Knowledge of ICD-9, ICD-10, HCPS, and CPT coding, medical terminology, Medicare reimbursement guidelines, billing practices.
• Knowledge of government regulatory requirements and commercial contracts.
• Advanced computer knowledge, including Window based programs.

SKILLS

• Skill in providing excellent customer service.
• Skill in using computer programs and applications.
• Skill in establishing good working relationships with both internal and external customers.

ABILITIES

• Ability to multi-task in a fast-paced environment.
• Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.

ENVIRONMENTAL WORKING CONDITIONS

• Normal office environment.
• Extended work hours at or near month end to meet department objectives may be necessary.