Job Duties

• Monitor commercial, government, and specialty payer claims to ensure timely follow up and claims resolution.
• Maintain working knowledge of all payer guidelines and requirements as they relate to denials and appeals.
• Make changes to demographic information as necessary to produce a clean claim.
• Meet or exceed productivity standards in the completion of daily assignments and accurate production.
• Responsible for reviewing and understanding medical records, provider notes, Explanation of Benefits, etc. for knowledge of appeal or account resolution.
• Facilitates and initiates appeals to insurance companies for claim resolution.
• Handles correspondence requests from payers to ensure all information that is required for claim processing is provided in a timely manner.
• Analyze coding to ensure proper billing of claim. Experience with claims follow up, denial posting, claim processing, and appeals.
• Adhere to quality and productivity standards assigned by management.
• Ensure statements are generated for the patient responsibility amounts.
• Utilize insurance websites to view and resolve claims.
• Perform extensive account follow-up and provide analysis of problem accounts.
• Document all follow up efforts in a clear and concise manner into the AR system.
• Audit and research accounts, payment and contractual postings, and patient payments to confirm the accuracy of the balance of the account.
• Ability to identify and report payer trends that may provide insight into payment challenges. Collaborate with management on difficult or reoccurring denials.
• Phone contact with patient, physician office, insurance company, etc. for additional information to process the claim.
• Ability to assign CPT/ICD-9/10 and HCPCS codes from surgical/progress note.
• Attention to detail with the ability to identify/resolve problems and document the outcome.
• Regular and reliable attendance.
• Strong telephonic communication skills with a pleasant and friendly demeanor.

• Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies.
• Knowledge of general insurance requirements, working denials, and submitting appeals.
• Experience working directly with EOBs and contractual adjustments.
• General computer knowledge, working with electronic filing.
• Ability to communicate verbally/in writing with professionalism.
• Ability to meet productivity expectations

• Medical terminology
• HIPAA privacy laws