Duties and Responsibilities:
- Prepares and submits physician claims to third party insurance carriers either electronically or by hard copy billing.
- Secures needed medical documentation required or requested by third party insurances.
- Follows-up with third party insurance carriers on unpaid claims until claims are paid or only a self pay balance remains.
- Appeals insurance denials as appropriate.
- Processes rejections by generating a billing statement or by correcting any billing errors and resubmitting claims to third party insurance carriers.
- Works with physician or medical coding staff to ensure that correct diagnosis/procedure codes are reported to third party insurance carriers.
- Assists Charleston ENT Physicians, management, and staff with questions or problems related to insurance billing and reimbursement.
- Maintains reports for review by Physicians, Billing Manager, management, and staff. Monitors claims for missing information, authorizations, and denial notifications.
- Receives itemized list of proper payment postings and compares total to payment method received from insurance carrier.
- Posts third party insurance payments and denials to patient’s accounts.
- Posts payments made by patients to include cash, checks, and credit cards.
- Runs credit card charges.
- Updates patient’s accounts with regards to billing status.
- Performs charge entry for assigned offices.
- Manages third party authorizations for procedures and products.
- Answers customer inquiries by phone, fax, and email. Processes patient refunds.
- Enters patient demographics.
- Balances at the end of the day.
- Work special reports and projects.
- Keeps updated on all billing and benefit changes for third party insurance carriers within their area of responsibility and reports these changes to Billing Manager.
- Maintains confidentiality of all information.
- Completes work within authorized time to assure compliance with departmental standards.
- Demonstrates knowledge of, and supports, practice mission, vision, value statements, standards, policies, and procedures, operating instructions, confidentiality standards, and the code of ethical behavior.
- Performs others duties as required.