Responsibilities
- Prepare, review, and submit claims to insurance companies, government payers, and patients in compliance with payer guidelines and applicable regulations.
- Track denied or unpaid claims, investigate issues, and resubmit corrected claims as necessary. File appeals to maximize reimbursement for services.
- Ensure proper use of CPT, ICD-10, and HCPCS codes, maintaining compliance with federal and state regulations.
- Record insurance and patient payments accurately within the billing system, ensuring proper allocation and adjustments.
- Monitor unpaid claims and account balances, keeping accounts receivable days within target (e.g., 30-45 days).
- Address billing inquiries and assist patients with payment options, setting up payment plans as needed.
- Support collections efforts for overdue accounts while maintaining positive patient relationships.
- Run reports on claim statuses, account balances, and revenue trends to support billing performance monitoring.
- Work with providers and administrative teams to clarify documentation or coding issues.
- Respond to emails and telephone inquiries, manage shared mailboxes, and perform other administrative tasks as assigned.
Qualifications
- Familiarity with payer guidelines, claims adjudication, and appeals processes to optimize reimbursement.
- Knowledge of HIPAA and confidentiality standards to handle patient data appropriately.
- Experience in managing patient interactions and expectations, ideally in a healthcare environment.
- Proficient with Microsoft Excel, Word, and email platforms (Outlook, Gmail).
- Demonstrates initiative and drive to achieve goals without constant supervision.
- Maintains a systematic approach to managing tasks and responsibilities efficiently.
- Strong time management skills to execute tasks effectively to meet deadlines and maintain workflow.
- Ability to analyze challenges and develops practical solutions in a timely manner.
- Willing to learn and integrate new technologies and procedures as needed.
Screening Criteria
- At least one (1) to two (2) years of experience in medical billing, claims processing, or AR management/collections within a healthcare setting.
- Must have a stable employment history.
