Principal Duties and Responsibilities :

• Coordinates, monitors, and manages the follow-up on unpaid claims. Ensures follow-up and reimbursement appeals of unpaid and inappropriately paid claims.
• Identifies, researches, and ensures timely processing of billing errors and corrections as they relate to claims. Actively participates in problem identification and resolution and coordinates resolutions between appropriate parties.
• Ability to communicate and collaborate effectively with other internal as well as external resources to achieve desired results and resolve issues.
• Review and work all daily correspondence. Appeals denied claims via mail, telephone, or websites. Perform audits on accounts when needed to review for accuracy.
• Update accounts with information obtained through correspondence and telephone. When necessary, contacts patients, referring providers or a hospital to obtain better insurance information, authorization, or updated patient demographics to assist with collections.
• Completes appropriate account maintenance by ensuring that the correct statement groups, financial class, and payer codes.

Accurately documents all follow up on the account to ensure there is an accurate record of the steps taken to collect on an account.

• Meets the current productivity standard which include both quantity and quality metrics.
• Keeps current with health care practices and laws and regulations related to claims collections.
• Performs other job-related duties within the job scope as requested by Management.

Position Qualifications :

Education :

• High school diploma or equivalent certification required
• Associate degree or equivalent from a two-year college preferred; or equivalent combination of education & experience.

Experience :

• 3 to 5 years of health care claims reimbursement and denial resolution experience
• Knowledge of Major Commercial (Aetna, BCBS, Cigna, UHC) as well as Medicare / Medicaid payer guidelines
• Retina experience preferred but not required

Knowledge, Skills, Abilities :

• Strong computer skills (including MS Word and Excel)
• Ability to maintain accuracy while working on multiple tasks in a fast-paced environment under low-to moderate supervision
• Ability to ensure confidentiality of sensitive information and maintain HIPAA compliance
• Dependable in both production and attendance
• Exceptional organization and time management skills

Last updated : 2024-04-30