Medical Billing Specialist: AR & Claims Expert

Maintenance of account which includes AR follow up, payment posting & balancing, filing claims & managing rejections, as well as generating statements and receiving inbound patient calls. Responsibilities:

• Contact insurance companies regarding claims.
• Process and follow up on appeals to insurance companies.
• Filing of all claims.
• Post and balance payments, if applicable
• Maintain productivity standards and goals set by the department and/or manager.
• Maintain standard quality measures and goals.
• Proactively resolve any cash restraining issues by seeking out and identifying trends in each facility’s AR
• Follows up on non-responded and denied insurance claims for all third-party carriers (Self-Pay, Private, HMO/PPO and Gov’t payers).
• Processes insurance/patient correspondence with insurance carriers to resolve adjudication issues.
• Resolve any issues affecting reimbursement and/or adjudication in a timely manner
• Available to patients and clinical departments to address specific payer issue
• Provide feedback to Revenue Cycle Management based on the monthly review of AR
• Maintain strict confidentiality within medical practice and HIPAA compliance.
• Attend Meetings as required and/or participate in various committees as required
• Other duties as assigned by, Manager, Director, VP RCM.

Required Skills:

• High school diploma/GED
• Preferably two years’ prior experience in physician professional billing (Managed Care, Commercial and or CMS Part B claims adjudication, including but not limited to:

• Explanation of Benefit forms (EOB)
• Credit balances (discounts and refunds)
• Insurance carrier billing requirements
• Collections
• Familiarity of payer provider enrollment

Core Competencies: Accountability and Self-Management

• Must be detail-oriented and organized
• A self – starter capable of tracking to deadlines and meeting goals with little supervision required
• A high level of analytical and problem solving skills is expected

Teamwork and Leadership • Ability to work autonomously and as a team player, and display some leadership qualities Communication

• Excellent communication, customer service, and organizational skills
• Strong verbal and written communications is desirable;

Innovation and Problem Solving • Attention to detail and moderate analytical and problem solving skills is expected Computer Skills

• Must possess general office skills and computer knowledge
• Strong working knowledge of the Aprima EPM practice management system and/or GE Centricity Business system and coordinating modules, is preferred
• MS Excel Spreadsheet software, MS Word Processing software and MS Power Point software.

Physical Demands:

• May require sitting for long periods of time; also, stooping, bending, and reaching for files and supplies.
• Requires manual dexterity sufficient to operate a computer keyboard, answer a telephone, and run a copier and other office equipment as necessary.
• Employee must participate to help maintain the desirable work environment created by the management and company officials.

Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Aprima