ESSENTIAL DUTIES AND RESPONSIBILITIES:

1. Uphold and support the philosophies, objectives and policies of CHSI.
2. Directly responsible for handling “Customer Service” questions regarding any eligibility or billing issues in a professional manner.
3. Uses professional ethics in regards to handlings of confidential information of patients.
4. Responsible for keeping accurate information on all patient referrals payments so when outside billing comes in we have accurate resources to assure we need to pay them.
5. Provide assistance as needed to other clinic personnel regarding coding, patient account status, Medical eligibility, etc.
6. Perform all other duties and responsibilities that may be added, deleted, or changed at any time at discretion of management, formally or informally, either verbally or in writing.
7. Directly responsible for daily filing of encounter forms, and/or any other billing related forms you may attend to daily.
8. Directly responsible for back-up to answering telephone calls and taking appropriate messages as required.
9. Perform audits on Accounts Receivable billing records to determine what claims were submitted to insurance payers for reimbursement. Review explanation of benefit (EOB) of claims submitted which were denied or underpaid based on contract matrices, fee schedule or incorrect procedure code billed. Corrected and re-submitted claims on appeal and grievance for payment of services rendered.
10. Verify that proper procedures and diagnosis codes are billable claim form.
11. Submission of appeals with invoices for reimbursement on underpaid claims.
12. Working knowledge of all insurance payer products HMO, PPO, POS, EPO managed care, commercial and government payers. Consistent telephone and written contact for payment and resolution.
13. Submission of appeals to insurance companies, IPA, Medical Groups and third party payers to obtain additional payment for underpaid claims.
14. Submit adjustments for co-payments, deductible and coinsurance billing to members and patients.
15. Post insurance payments, client’s payment, into computer system.
16. Run Report.
17. Analyze patient information for completeness.
18. Verify insurance coverage with third party payers.
19. Audit, prepare and file cases.
20. Patient charts/Data entry
21. Mailed out CMS 1500 forms/verity eligibility
22. Filing, faxing, customer service and heavy data entry.