Responsibilities
- Resolve electronic claim submission errors and rejections.
- Verify patient and insurance eligibility on payer websites.
- Review and respond to patient inquiries promptly and professionally.
- Address and resolve inquiries from clinical and front office staff.
- Post insurance remittances via 835 electronic download or through the EFT system.
- Enter insurance remittances and summaries through data entry.
- Post payments related to medical record releases.
- Balance insurance receipt batches, ensuring accuracy in payments, adjustments, and patient billing responsibility amounts.
- Follow up on insurance denials and rejections based on remittance advice.
- Understand the claims appeals process and file appropriate documents with insurance payers.
- Submit secondary insurance claims and attachments electronically.
- Audit patient accounts and request patient or insurance refunds in a timely manner.
- Conduct monthly follow-up on insurance aging reports to meet or exceed company standards.
- Attend weekly staff meetings and participate in ongoing training.
- Retrieve and respond to voicemail messages related to business office inquiries.
- Maintain current knowledge of coding, medical policy changes, and billing service requirements.
- Communicate pertinent billing and insurance payer changes to providers and clinical staff.
- Participate in billing audits for compliance and adherence to regulations.
- Uphold HIPAA privacy and security regulations.
Qualifications
- Proficient in reading, writing, and interpreting business documents, with a solid understanding of medical policy, coding, and payer billing regulations.
- Strong customer service skills with the ability to communicate effectively with patients, co-workers, and providers.
- Clear and coherent in both written and verbal communication skills with a positive attitude and flexibility.
- Advanced computer skills, including proficiency in MS Office and 10-key data entry.
- Ability to work independently while effectively managing time and prioritizing multiple assignments.
- Has a strong focus on accuracy in financial reporting and the ability to interpret complex instructions.
- Sound judgment in recognizing problems, evaluating alternatives, and implementing solutions.
- Ability to maintain composure in challenging situations and handle conflicts professionally.
- Keeps abreast of changes in policies and procedures related to professional billing services.
- Fosters a positive team environment and supports colleagues in achieving departmental goals.
- Takes responsibility for personal actions and ongoing self-development; develops creative solutions to improve productivity.
Screening Criteria
- Bachelor’s degree in a related field or an equivalent combination of education and related work experience.
- At least two (2) to four (4) years of healthcare experience in accounts receivables required with related training.
- Must have stable employment history
