PRIMARY FUNCTION: This position is responsible for resolving clearinghouse rejections and denials as assigned to ensure accurate and timely electronic and paper claims generation. The data integrity and transmission to/from the billing system, claims clearinghouse(s), financial systems and lockbox and edit systems must be accurate, transmitted and reconciled daily without disruption to avoid cash flow delays.
REPORTS TO: Reports to Revenue Operations Manager
ESSENTIAL FUNCTIONS OF THE JOB: (This list may not include all of the duties that may be assigned.)
1. Responsible for reviewing billing rejections and improperly processed claims via the practice management system to ensure proper processing of claims. Identify and correct claim processing (data entry, verification, coding and/or posting) errors for assigned projects. Ensure accounts are properly documented for the improvement of overall quality.
2. Communicates via verbal and/or written correspondence to departments, external agencies, or patients to verify patient and claim information in order to process claims.
3. Identify payer trends and report any escalate issues that could not be resolved. Collaborate and provide feedback to Manager and Revenue Integrity Team.
Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI in accordance with organizational policy, Federal, State, and local regulations.
TYPICAL WORKING CONDITIONS:
* Indoor Work
* Operating Computer
* Reach Outward
* Manual Dexterity
* Lift/Carry 10 lbs. or less
* Push/Pull 12 lbs. or less
Other Physical Requirements
* Sense of vision
* Sense of sound
* Sense of touch
* Ability to wear personal protective equipment (PPE) as needed
EDUCATION: High School Diploma or equivalent required.
*Upon hire, and for the duration of the employment period driver’s license must be active and valid.*
EXPERIENCE: 3 years of insurance/collection experience is preferred. Previous health care experience required.
KNOWLEDGE, SKILLS & ABILITIES:
* Knowledge of billing and collection policies/procedures, CPT and ICD-10 codes
* Knowledge of various insurances (HMO, PPO, POS, Medicaid, etc.)
* Skill in defining problems, collection of data, and interpreting billing information
* Ability to communicate effectively and in writing
* Ability to multi-task in a faced paced environment
* Ability to prioritize work