Responsibilities
- Examine medical claims to ensure accuracy and completeness.
- Verify health insurance benefits and coverage for patients.
- Follow up with payers regarding claim status and outstanding balances.
- Identify and resolve issues preventing timely claim resolution.
- Correct and resubmit claims as necessary to ensure prompt payment.
- Maintain detailed documentation of all billing and collections activities.
- Provide expert customer service to patients and insurance providers.
- Ensure compliance with legal and regulatory requirements at all times.
Qualifications
- In-depth understanding of insurance plans, including knowledge of different types of insurance coverage, member eligibility criteria, and medical billing processes.
- Proficiency in medical billing codes and terminologies, including CPT, ICD-10, UB, HCFA, and 837 formats.
- Strong interpersonal and customer service skills, with the ability to communicate effectively with patients, insurance providers, and internal stakeholders.
- Meticulous attention to detail and problem-solving abilities, with a track record of accurately identifying and resolving billing issues.
- Ability to gather, assess, and interpret relevant data and information to make informed decisions and address complex billing or claim-related inquiries.
- Proficiency in mathematical calculations and numerical analysis, crucial for tasks such as calculating patient co-pays, deductibles, and insurance reimbursements accurately.
- Strong aptitude for accurately recording and maintaining detailed documentation of billing and collections activities, including patient information, claim status updates, and resolution actions.
- Demonstrated ability to meet and exceed productivity goals, with a focus on efficiency and accuracy in claim processing.
Screening Criteria
- Highschool diploma or equivalent combination of education and related work experience.
- At least one (1) to five (5) years of experience in Revenue Cycle Management.
- Must have stable employment history
