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Responsibilities :

Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission

Knowledge of insurance billing in the following areas : Worker's Comp and Motor Vehicle Claims in NJ and NY

Work directly with third party payers, internal and external customers, and other contract clients toward effective and efficient collection results on accounts assigned by management in accordance with departmental policy and procedures

Ability work well independently and communicate efficiently and respectfully with patients and insurance representative

Must have experience with Worker's Comp and No Fault PIP in New York and New Jersey billing and reimbursement regulations

Identify billing errors and denials, by understanding the problem and resubmit corrected claims or take other appropriate action resolutions.

Be able to negotiate settlements

Be able to communicate with law firms that are processing arbitration on behalf of hospital.

Send appeals for : low reimbursement, no authorizations, timely filing, medical necessity etc. with correct documentation.

Submit paper claims to primary and secondary insurance with correct documentation, ie : operative reports, implant invoices, primary eob's

Adjust claims for correct fee schedule, incorrect payments and patient responsibility.

Scan work and correspondence daily and maintain clear detailed notes

Maintains a thorough knowledge of third party billing and collection requirements for payers assigned for handling.

EDUCATION / EXPERIENCE REQUIREMENTS

High School Diploma or equivalent

Minimum 5 years billing and follow-up experience

Coding certification preferred but not required.