Medical Biller/Denials Specialist (Hybrid)

Job Overview:

Responsible for the reimbursement and/or resolution of patient insurance account balances with the goal of working accounts to resolution.  This role performs account management and analysis; as well as complete, timely and accurate follow up of insurance (hospital, physician or ASC) account balances with the objective of optimizing insurance reimbursement. 

Primary Job Duties:

• Maintain a professional and compassionate demeanor in all interactions with our patients. 
• Work all insurance follow up (hospital, physician and ASC), which includes a focus on claims that have been denied, need more information or are paid incorrectly by insurances.
• Interacts with, and leverages, external and internal resources to overcome barriers, problem solve and ultimately resolve insurance account balances.
• Communicate effectively with patients, physicians, contracted insurances and third party payers.
• Review and determine appropriate actions for claim follow up, including but not limited to, appeals, insurance website inquiries, calls to insurance customer service representatives, etc.
• This role is accountable for understanding and reconciling insurance practices such as: confirming a claim has been received, validation of denied charges, and collaboration with site resources to ensure denials are appealed timely and submitting information requested by insurance companies for denied claims.
• Updates insurance information and routinely adds account notes to each account worked.
• Identify questionable accounts/bills, problematic payers or unusual situations and brings to the RCM.
• Identify and escalate any payer trends identified to resolve and/or mitigate issues.

Secondary Job Duties:

• Provide feedback to the RCM to address any issues related to insurance reimbursement and claims resolution.
• Update personal job knowledge by participating in educational opportunities; reading professional publications, etc.
• Possesses a thorough knowledge of DHS billing procedures, payer policies, CMS guidelines and general compliance principles.
• Abides by all DHS policies and procedures and maintains excellent attendance.
• Perform other duties as needed or assigned by Revenue Cycle Manager.

Qualifications:

• High school diploma or equivalent
• 3-5 years medical billing experience required
• CPB preferred or equivalent experience with advanced knowledge of medical terminology, ICD 10, CPT/HCPCS codes and HIPAA laws.

Skills and Proficiencies:

• Ability to interpret EOBs and navigate insurance policies.
• Proficient in Epic Resolute Billing
• Well-organized with attention to detail
• Proficient with technology, spreadsheet management skills with the ability to analyze trends.
• Excellent organizational skills, ability to manage multiple priorities and responsibilities.
• Ability to establish and maintain effective working relationships with team members, clinic staff and patients
• Have a desire and dedication to work with self-discipline
• Maintains the strictest confidentiality: adheres to all HIPAA guidelines and regulations
• Ability to sit for long periods.  Work required walking, bending, standing, sitting, and reaching