• Reviews and resolves complex issues that result in payer denials, including appeals, coding corrections, medically necessity rules and other related functions.
• Assists the auditor in reviewing notes for medical necessity.
• Works with the authorization department to resolve authorization issues with complex procedures.
• Runs and maintains tracking logs to track complex high dollar procedures and report the results to the billing department management team.
• Contacts the various Provider Service Representatives to resolve repetitive payment issues
• Acts as a resource for the Billing Staff for complex issues.
• Analyzes and resolve billing issues, keeping A/R to no more than 10% over 60 days.
• Processes daily correspondence, claim status, handle denials, appeals and re-bills.
• Answers billing questions and inquiries from patients and internal staff.
• Updates patient files with address changes, contact information changes, etc., as needed.
• Reviews all policy changes on a regular basis and informs supervisor and charge entry specialist of such changes.
• Efficiently navigates assigned insurance companies' proprietary websites to find policies, research payments, etc.
• Keeps supervisor apprised of matters regarding accounts receivable.
• Responds to requests from billing company in a timely fashion.
• Researches denials and submits correct claims/medical documentation.
• Reviews and manages claims within the work dashboard hold buckets for resolution.
• Creates, maintains and updates reports, as directed.
• Exercises confidentiality in all areas, abiding by HIPAA rules and regulations.
• Helps train new revenue cycle staff.
• Collects and reviews end of day reports.
• Checks work e-mail on a regular basis throughout the workday.
• Participates in and complete all required trainings and in-services.
• Performs other duties as assigned.

Minimum Qualifications: