JOB SUMMARY: Ability to identify reimbursement trends. Follows up on rejected claims and under payments using Practice Management software and Explanation of Benefit forms. Builds and maintains relationships with specified payors.

EDUCATIONAL REQUIREMENTS:

• High school diploma required
• College education or trade school preferred
• Certified Professional Coding certification helpful

QUALIFICATIONS AND SKILLS:

• Minimum 1 year experience working in a physician group practice billing department
• Working knowledge of CPT and ICD10-CM coding for Orthopaedic surgery
• Comfortable using email and interacting with Internet applications
• Experience with EMR, PM system, and word processing software
• Able to establish good relationships with insurance companies
• Good analytical skills and an affinity for detail
• Ability to read and analyze accounts receivable and payor reports
• Pleasant speaking voice and demeanor
• Neat, professional appearance
• Strong written and verbal communication skills

Essential responsibilities include, but are not limited to:

Account Follow Up

• Follows up on rejected claims the day that the rejected EOB is received
• Using data from the monthly aged accounts receivable report, calls payors or looks up claims status online to inquire about unpaid insurance claims that are 45 days old; records response or activity in the computer system "notes"
• Makes necessary arrangements for medical records requests, completion of additional paperwork, etc., if payors request this information prior to payment of claims
• Responds to written and telephone inquiries from insurance companies
• Manages relationships with personnel from assigned carriers
• Calls carriers to appeal payments that do not match contractual agreement; notifies Manager of payors for which this is a consistent problem
• Asks physicians or CPCs to provide appeal language for denials, or to support medical necessity
• Processes requests for refunds, and submits to Director of Revenue Cycle Management for approval
• Meets with Accounts Receivable Team regularly to discuss and solve reimbursement and insurance follow up problems

Other

• Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice
• Attends regular staff meetings as requested
• Attends continuing education sessions as requested
• Performs any additional duties as required by the Billing Department

Typical Physical Demands

Work may require sitting for long periods of time, and also stooping, bending and stretching for files and supplies. Employee will occasionally be asked to lift files or paper weighing up to 30 pounds. Position requires manual dexterity sufficient to operate a keyboard, operate a computer, telephone, copier, and such other office equipment as necessary. Vision must be correctable to 20/20 and hearing must be in the normal range for telephone contacts. Position also requires viewing computer screens and typing for long periods.