Medical Billing & Follow-up Specialist

$16-$18/HR, DOE | M-F 7:30am-4pm

Job Description

• The Billing & Follow-Up Representative reviews, researches, and processes claims in accordance with contracts and policies to determine the extent of liability and entitlement, as well as to adjudicate claims as appropriate.

• The Billing & Follow-Up Representative reviews, researches, and processes claims in accordance with contracts and policies to determine the extent of liability and entitlement, as well as to adjudicate claims as appropriate.

• The core responsibilities will include: coding and processing claim forms; reviewing claims for complete information, correcting and completing forms as needed; accessing information and translating data into information acceptable to the claims processing system; and preparing claims for return to provider/subscriber if additional information in needed.

• Additional follow-up responsibilities include: maintaining all appropriate claims files and following up on suspended claims; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general inquiry issues, then communicating the results; and preparing formal history reviews.

Qualifications

• High school diploma or an equivalent combination of education and experience

• Data entry skills (50-60 keystrokes per minutes).

• Past work experience of at least one year within a hospital or clinic environment, an insurance company, managed care organization or other financial service setting, performing medical claims processing, financial counseling, accounting, financial clearance and/or customer service activities is required.

• Knowledge of insurance and governmental programs, regulations and billing processes (e.g., Medicare, Medicaid, Social Security Disability, Champus, Supplemental Security Income Disability, etc.), managed care contracts and coordination of benefits is strongly preferred.

• Working knowledge of medical terminology, anatomy and physiology, medical record coding (ICD-9, CPT, HCPCS), and basic computer skills are highly desirable.

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