Medical Billing - Claim Follow-up & Resolution

Job description

We are seeking an experienced Medical Billing - Revenue Cycle Management specialist to join our medical billing team. The ideal candidate will have a strong understanding of medical billing processes and terminology, experience in follow-up for Out-Of-Network providers, ensuring accurate and timely follow-up on billed claims.

Roles & Responsibilities:

• Responsible for claims follow -up, Professional and Facility, from claim submission until final payment
• Communicate with insurance companies regarding claim denials or underpayments
• Utilize Payer Online Portals such as Availity, Cignaforhcp, UHC, Navinet, Emblem for claims status and eligibility verification
• Send Medical Records to payers, filing reconsiderations and appeals
• Utilize providers EMR’s to obtain Medical Records
• Reading and understanding various payers EOB’s
• Posting payments, writing off balances and sending statements to patients, when necessary
• Communicating with 3rd party payers such as Multiplan, MARS and Zelis regarding OON claim negotiations.
• Follow up on Pre-negotiated Agreements a/k/a Single Case Agreements
• Review and verify accuracy of billing data utilizing Optum EncoderPro
• Utilize medical collection systems to track and collect payments
• Ensure compliance with all relevant coding and billing regulations
• Effectively resolve complex issues, including payment research, payment recoupments
• Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions

Experience & Requirements:

• Knowledge in Multi-Specialty coding - CPT and ICD codes for many different specialties
• Experience working with medical billing software like Imagine and ADS
• Familiar with Gap (Network Deficiency) exception and prior authorizations process
• Familiar with Federal IDR arbitrations process
• Familiar with OON Provider Registration Process with various Payers
• Knowledge of medical terminology (Hicfa, UB04, Tax ID, NPI)
• Strong attention to detail and persuasive telephone skills
• Excellent communication and interpersonal skills
• Solid skill with Microsoft Office applications: Word, Excel, Teams, Power BI reporting, Zendesk
• High School Diploma or equivalent

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Work Location: In person

Job Type: Full-time

Pay range: $60,000 - $70,000 (annual Salary is Commensurate with Experience)

Ability to Commute:

• Boca Raton, FL 33433 (Required)

Ability to Relocate:

• Boca Raton, FL 33433 - Relocate before starting work (Required)

Job Type: Full-time

Pay: $60,000.00 - $70,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Ability to Commute:

• Boca Raton, FL 33433 (Required)

Ability to Relocate:

• Boca Raton, FL 33433: Relocate before starting work (Required)

Work Location: In person

Salary : $60,000 - $70,000