Job Description:
• Access and navigate payer websites and portals to verify eligibility, authorization, and claim status.
• Update patient demographics and insurance information in appropriate systems.
• Research and resolve unpaid or denied claims, including missing information, authorization, and control numbers (ICN/DCN).
• Review EOBs for adjustments and process corrections to resolve claims.
• Contact insurance payers via phone or written correspondence to secure payment of claims.
• Research and respond to payer requests for additional documentation.
• Verify accuracy of underpayments using contracts and claims data.
• Write appeal letters for technical appeals and denial management.
• Prepare claims for clinical audit processing (authorization, coding, level of care, length of stay denials).
• Maintain confidentiality of patient information in accordance with HIPAA regulations and company policy.
• Collaborate with billing teams, coders, and payment posters to ensure accurate claim processing.
• Document all claim activity, follow-ups, and resolutions in the billing system.
• Adhere to payer policies, guidelines, and submission requirements.
• Perform other related duties as assigned by the AR Manager or Supervisor.
Qualifications:
• Experience using Microsoft Word and Excel.
• Familiar with ICD-10, CPT, HCPCS, and NCCI.
• Familiar with billing claim forms (UB04/1500).
• Hands-on experience with health information systems (EMR, Claim Scrubbers, Patient Accounting Systems, etc.).
• Knowledge in third-party billing guidelines and payor contracts.
• Demonstrates strong organizational and time management skills with the ability to prioritize tasks effectively.
• Detail-oriented with high accuracy in claim documentation and processing.
• Clear and coherent both written and verbal communication skills in English.
Screening Criteria:
• High school diploma or equivalent required.
• Minimum of two (2) years of experience in medical collections or billing.
• Minimum of two (2) years of experience using EPIC healthcare software.
• Must have a stable employment history.
