Medical Billing and AR Specialist

Job Description

Primary Responsibilities:

• Responsible for obtaining authorization for pain management procedures from insurance companies.
• Responsible for Billing and Coding, Pre Certification and Credentialing
• Responsible for collecting, outstanding account payments.
• Responsible for following up with insurance companies and patient accounts.
• Has knowledge of commonly-used concepts, practices, and procedures within the Medical Billing and Medical Insurance field
• Complete multiple tasks simultaneously
• Work independently, detail oriented and organized
• Proficient w/ government and commercial Understanding of insurance websites and form fields for authorization submission
• Maintain up to date information on various insurance companies and any relevant changes
• Keeps management informed of changes or issues
• Completes other tasks or responsibilities as assigned
• Responsible to reduce aged A/R.
• Analyze Explanation of Benefits (EOB’s) and Correspondence to identify zero pays and underpayments.
• Responsible to follow-up with healthcare insurance companies on outstanding medical claims and appeals.
• Maintain open communication with the insurance verification team, billing department and office support staff.
• Conduct collection actions and provide resolution for complex accounts.
• Provide supporting documentation that supports collection actions.
• This position is responsible for obtaining and completing all insurance pre-certifications and authorizations as required for various clinical procedures.
• Determines necessity for pre-certification and coordinates with insurance companies, patients and clinical staff to obtain information.
• Maintains complete and accurate documentation in patient charts.
• Develops and maintains effective relations with insurance companies, physicians and medical office staff.
• Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow.
• This position requires the ability to work with minimal supervision.
• Monitor new patient report and maintain organized list with status of pre-certification process.
• Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information.
• Check insurance payment policy for scheduled procedures and obtain prior authorization when required.
• Verify receipt of all necessary pre-authorization documents prior to procedure
• Communicate effectively with the facility in which the procedure will be performed as needed.
• Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.
• Notify primary care physician for managed care plans that require PCP authorization.
• Serve as a resource on insurance, billing and customer service for reception.