Manages account receivables by preparing and submitting claims to insurance carriers, posting insurance and patient payments, performing follow up with insurance carriers on unpaid, rejected or denied claims and answering client and payer inquiries on account status and charges. Completes less routine assignments. Duties and tasks are more complex. Exercises judgment to solve more complex problems.
Role and Responsibilities:
- Enters information necessary for insurance claims such as patient, insurance ID, diagnosis and treatment codes and modifiers, and provider information. Insures claim information is complete and accurate.
- Submits insurance claims to clearinghouse or individual insurance companies electronically or via paper.
- Follows up with insurance companies for unpaid or rejected claims. Communicates with payors and other necessary contacts to resolve issue and re-submit claims as needed.
- Prepares appeal letters to insurance carrier when not in agreement with claim denial. Collect necessary information to accompany appeal.
- Prepares and submits secondary claims upon processing by primary insurer.
- Posts insurance and patient payments via electronic remit posting or manual posting.
- Answers client and payer questions on accounts receivable denials, adjustments, payments, charges, write-offs, etc.
- Prepares and reviews routine billing reports to ensure timely and accurate billing activity. Recommends process improvements based on findings.
- Completes other tasks and projects as assigned by Manager.
- Adheres to all organizational policies and procedures.
- Executes all tasks and behaves in a manner consistent with a culture of compliance, safety and a high reliability organization; behavior supports the organization's core commitments of Integrity, Service, Respect, Teamwork, Excellence, and Innovation.
Qualifications and Education requirement:
- High school diploma or GED and a certificate program or an associate's degree in related field required. Bachelor’s degree in related field preferred.
- A minimum of 2 years' relevant experience required.
- Applies more advanced skills and knowledge in the area of specialization. Requires critical thinking skills and decisive judgment. Works under general supervision. Must be able to work in a stressful environment and take appropriate action.