SECONDARY BILLING & FOLLOW-UP REPRESENTATIVE

Definition and Role

Under the direction of the Assistant Director of Revenue Cycle – Revenue Recovery, the Remote Secondary Billing & Follow Up Specialist is responsible for monitoring billing & claims follow up on all claims and resolutions from participating insurance carriers and working proactively to collect from secondary insurance carriers.

Job Responsibilities and Duties

• Responsible for billing 60-65 claims per day.
• Familiar with Medicare, Medicaid & Blue Cross Payers
• Duties include editing claims, billing out claims & following up with secondary payors.
• Previous experience Nextgen Meditouch software
• Knowledge of insurance Payers, EMR,Claims.
• Performs follow up on all outstanding accounts assigned in accordance with established standards & procedures.
• Assists with chart audits as necessary.
• Reviews & edits any rejections stemming from electronic billing submission, correct & resubmit the claims.
• Researches, responds, and documents insurer and patient correspondence/inquiry notes regarding coding coverage, benefits, and reimbursement on patient accounts.
• Responds to telephone inquiries from patients, insurance carriers and outside agencies in a courteous manner.
• Makes management aware of any issues or changes in the billing system, insurance carriers, and/or networks.
• Send secondary claims to appropriate payers.

Physical Requirements

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

1. While performing this job the employee is frequently required to sit, talk, and listen.
2. The employee is occasionally required to walk, use hands and fingers to feel, handle, or operate objects, tools, or controls, and reach with hands and arms.
3. The employee must occasionally lift and/or move objects weighing up to 25 pounds.
4. Specific vision abilities required by this job include close vision and the ability to adjust and focus.
5. Emotional/Psychological: Constant ability to make decisions and concentrate.

Qualifications

• Entry Level Position
• Demonstrated understanding of medical terminology, Insurance, EMR, & Claims required.
• Knowledge of patient confidentiality and HIPAA regulations.
• Knowledge of CPT, HCPCS, and ICD10 coding required.
• Knowledge of medical billing and collection practices.
• Understands Medicare and Medical Assistance regulations as they apply to job functions.
• Knowledge of working with electronic health records (EHR/EMR) or healthcare related computer systems.
• Establishes and demonstrates competency in accounts receivable systems & associated applications.
• Ability to communicate effectively with insurance carriers, patients, and co-workers.
• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the norm.
• Excellent verbal and auditory skills are required for communicating with internal staff and representatives from external departments & agencies.