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Performs follow up and collects on insurance balances, including governmental payors and workcomp, through the use of various systems and reports.
Requirements:
1-3 years’ experience
High School Diploma or GED
Minimum of 1 year claims billing experience in a healthcare setting
Major Responsibilities:
Work denials and zero pay Explanation of Benefits and Remittance Advices to determine liability and appropriate action to ensure reimbursement.
Maintain payor AR days through effective collection, account resolution, and proper monitoring of receivables. Document all transactions in the patient account system.
Process correspondence, EOB's, RA's, system reminders, and interoffice mail in a timely manner with no more than a five day backlog. Identify payment and denial trends for payors and address them promptly.
Updates/revises standard work processes regularly, ensuring they are current. Actively contributes to continual process improvements.
Submits corrected claims as needed to payors.
Identifies denials and submits timely appeals ensuring all documentation needed (including medical records) to support the appeal is submitted then reflecting accounts have been prorated accordingly.
Maintain active communication with payors until account is paid/denied, or balance becomes the patient's responsibility.
Monitor various payor systems to ensure suspended/pended claims are resolved in a timely manner, ensuring that they do not "drop" from the system. Follow up timely.
Run weekly and monthly reports, including Aged Trial Balance, to effectively monitor accounts receivable.
Provides back up to peers as needed and performs all other duties as assigned.