Overview

Responsible for working claims rejected by the clearinghouse and payer's EDI edits. Reconcile all outgoing claim batches within ECW and clearinghouse.

Responsibilities

ESSENTIAL FUNCTIONS:

• Work claims rejected directly by the clearinghouse
• Work claims rejected directly by the payer’s EDI edits
• Reconcile all outgoing claim batches within ECW and clearinghouse
• Balance secondary claims
• Review claims with errors (batch submission error) to ensure claims go out clean upon first submission
• Give feedback regarding errors/trends to appropriate management/departments
• Ability to identify errors and resolve accordingly
• Previous experience with health insurance payers and eligibility processes, preferred not required.
• Previous A/R follow up experience preferred
• Familiar with EOB’s and era denials, ability to read them
• ECW and Trizetto experience preferred, not required.

Qualifications

REQUIREMENTS:

• High school diploma or equivalent
• Previous experience with medical billing systems required
• Knowledge of CPT, ICD-9/10 and HCPCS codes
• Attention to detail with the ability to identify/resolve problems and document the outcome
• Strong written and verbal communication skills
• Excellent analytical and problem-solving skills
• Ability to multi-task and recognize trends
• Solid skill with Microsoft Office applications: Word, Excel
• Initiative to learn new tasks and the ability to apply acquired knowledge to future duties
• Flexibility, adaptability, and accountability are necessary for optimum client results