- Meets established daily productivity standards.
- Schedule and download the daily bill job files and processes for transmittal.
- Research, correct, and re-submit rejected and denied claims.
- Responsible for timely billing whether by paper or electronic claim in the appropriate claim format.
- Monitor insurance claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner- knowledge of questions to ask for proper processing.
- Responsible for identifying problems and solutions or enhancements to resolve billing issues including, but not limited to, billing frequency, required forms, and general billing requirements.
- Identify problem accounts and escalate as appropriate.
- Update the patient account record to identify actions taken on the account.
- Manages clearinghouse and payor accept / reject reports timely while ensuring all claim rejections are resolved within 72 hours of rejection occurrence.
- Logs repetitive errors or exceptions and reports them to management to ensure the admission record and related systems are properly updated and corrected.
- Coordinates with collectors and management to become familiar with the changing demands and requirements of payers in each state.
- Interacts with other areas and departments to troubleshoot and resolve issues that may not have standard documented solutions.
- Provide support to the Collectors by producing timely, accurate and complete billing documents.
- Stays abreast of changes in all editing processes as may be required.
- Acts as a resource for billing information and assists collectors and other staff members in producing any special documentation which may be required.
- Identify coding or billing problems from EOBs and work to correct the errors in a timely manner.
- Understands and serves and as subject-matter expert for billing specifications and requirements of assigned payers and states
- Understand Hospice Notice of Election (NOE) submission timing requirements and exceptions.
QUALIFICATIONS
- Three to four years prior experience in a general office environment (accounting or billing experience in a healthcare environment preferred)
- Knowledge of insurance billing guidelines including Medicare, Medicaid, and other third party payers.
- Possess a full understanding of the health care collections and reimbursement process, and an in depth knowledge of the insurance industry.
- Ability to work on various assignments simultaneously
- Strong interpersonal skills within all levels of the organization
- Ability to navigate within automated systems and proficiency in Outlook, Word and Excel
EDUCATION
Completion of high school or basic education equivalency required.
SPECIAL INSTRUCTIONS TO CANDIDATES
- EOE / AA M / F / D / V
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