Requirements
Responsibilities:
Analyze and resolve issues related to unpaid medical claims and denied claims.
Follow up with insurance companies to inquire about claim status and resolve issues.
Interpret Explanation of Benefits (EOBs) to ensure correct payment, adjustments, and patient responsibility.
Communicate with providers and patients regarding billing issues, as needed.
Document all activities related to accounts receivable follow-up in a consistent and comprehensive manner.
Meet key performance indicators as established by management, such as reducing the number of denied and rejected claims.
Review and appeal unpaid and denied claims.
Maintain patient confidentiality and adhere to HIPAA regulations.
Stay up-to-date with changes in medical coding and billing practices, insurance policies, and healthcare regulations.
Qualifications:
Bachelor's degree in Finance, Business, Healthcare Management, or a related field.
1-2 years of experience in medical billing or healthcare, preferred but not necessary.
Understanding of medical terminology, CPT, ICD-10, and HCPCS coding.
Proficiency in using medical software systems and Microsoft Office Suite.
Excellent written and verbal communication skills.
Detail-oriented with strong analytical and problem-solving abilities.
Understanding of insurance guidelines, including Medicare and state Medicaid.
Ability to maintain patient confidentiality and adhere to HIPAA guidelines.
Ability to work independently and collaboratively within a team environment.
Able to prioritize and manage multiple tasks simultaneously.
Strong customer service skills for interacting with patients regarding medical claims and payments.
Willingness to stay up-to-date with changes in healthcare laws and regulations.