Responsibilities
- Accurately key in data for surgical and clinic claims, adhering to industry coding standards and guidelines.
- Work collaboratively with cross functional teams within the organization to process patient requests and resolve queries efficiently.
- Diligently follow up on claims to optimize Accounts Receivable, ensuring timely and accurate reimbursement.
- Generate reports with actionable recommendations as per client requirements, supporting data analysis and strategic decision making.
- Demonstrate a deep understanding of Explanation of Benefits (EOBs) to facilitate claims resolution.
- Handle batch deposit and payment posting to maintain accurate financial records.
- Verify healthcare insurance details to ensure accurate claims submission and minimize denials.
- Verify and communicate patient responsibility, assisting patients in understanding their financial obligations.
- Leverage your knowledge of healthcare insurance, including Medicaid, to navigate payer specific requirements effectively.
- Engage in provider side insurance calls and maintain positive relationships with insurers.
- Other duties as assigned.
Qualifications
- Strong background in medical billing processes and procedures, including CPT and ICD 10 coding.
- Proficiency in claims follow up procedures, denials management, and appeals processes.
- Experience in engaging with healthcare providers and insurers to verify insurance details accurately.
- Ability to handle multiple tasks simultaneously and meet deadlines within the expected time frame as they will be handling 5,000 claims per month on an average to process.
- In depth understanding of healthcare industry regulations and compliance standards.
- Familiarity with healthcare billing software and electronic health record (EHR) systems.
- Ability to analyze claims data, identify trends, and provide data driven insights.
- Clear and coherent in both written and verbal communication skills, including effective provider side insurance communication and explanation of benefits (EOBs).
- Strong problem solving skills with a proactive approach to resolving issues.
- Attention to detail and accuracy in claims processing and record keeping to prevent errors and discrepancies.
- Adaptable to changing industry regulations, technologies, and procedures.
Screening Criteria
- Bachelor’s degree in a related field.
- At least one (1) year experience as a Medical Biller
- At least one (1) year experience with doing insurance verification.
- Must have a stable employment history.
