Job Description

1. Review and submit clean claim for payment

• Reviews and corrects all claim edits in the clearinghouse.
• Reviews and corrects all edits within the EMR software.
• Ensure proper secondary billing.
• Review and submit Paper claims with required attachments if appropriate.
• Verifies all unknown information with the appropriate department.

1. Process Medicare DDE.

• Review and correct all Medicare claim edits for submission to WPS.
• Review and correct all Return to Provider claims.

1. Completes Timely Follow-Up.

• Reviews account balances to ensure accuracy.
• Achieves department weekly goal for follow-up.
• Works with payers on denials with processes including, but not limited to, phone call verifications, medical records submission, reconsideration and appeals.
• Ensures the proper and timely submission of patient responsibility to statement vendor.

1. Completes Regular Review of Aging.

• Reviews aging reports on a regular basis.
• Completes frequent follow up on aged accounts.
• Reports issues to direct supervisor.

1. Performs other duties as assigned.

• Submission of reconsideration and appeals for payer denials as required.
• Completes and passed all training and exams.