Medical Billing - Claims Processor

Job Description

Job Description Long Term Temporary, Possible Temporary- to -Direct Hire Medical Billing/Claims Coordinator - Monday through Friday, 9am to 5pm, Fully On-Site.

Communicate via telephone and written correspondence with providers, members, attorneys, and collection agencies to resolve balance billing/fee negotiation inquiries.

Handle large call volume.

Negotiate and resolve balance billing inquires, negotiate fees and discounts for members with nonparticipating providers to reduce out of pocket expenses.

Analyze correspondence; verify member eligibility, claim history and coordination of benefits.

Review claims to determine if appropriate action was taken; follow up with Claims and Recovery Units to initiate adjustments and recover money.

Identify billing anomalies and alert the Fraud and Abuse Department to reduce fraudulent billing practices.

Triage balance billing/fee negotiation inquiries and ensure all documents are processed in a timely and efficient manner.

Research provider contracts and lease network reports to ensure providers are not breaching contracts by referring members out of network.

Perform additional duties and projects as assigned by management.