We are looking for experienced individuals only. Please DO NOT apply if you don't have Medical Billing experience! If you feel you are what we are looking for, please reply to this posting.
Follow up on accounts and resolution of claim denials in an expeditious manner. This will include communicating with insurance carriers, physician offices, patients, and management to achieve resolution of issues and claims payments. Out-Of-Network collections experience a must.
Strong problem solving good communications and professional attitude is the key for this role.
Responsibilities Include but are not limited to:
- Strong understanding of Out-Of-Network Collections and tactics to obtain high dollar reimbursement for non-contracted providers
- Review of payer correspondence (EOB’S) to determine next action item for resolution of claims.
*Continued monitoring and review of open Accounts Receivable to identify adjustment, refund, and payment breakdown amounts.
*Submission and composition of complete and detailed appeals, including all necessary follow up.
*Identify, and researching insurance company trends, both negative and positive and communicating the said updates regularly with collections manager and billing colleagues/ department.
*Review of aging reports, including monitoring delays in payments, past due statuses, and projective AR forecasts.
*Communication with provider offices, hospitals and any other referring healthcare professionals as needed for claims resolution.
*Demonstrated understanding of medical terminology, CPT and ICD9 Coding
*Exhibit strong working knowledge of out of network providers, TDI regulations, provider/health plan reconciliation process, and EDI reconciliation process.
- All other duties assigned.
- Minimum of 2 years experience in out of network surgery billing.
- In-depth Knowledge of billing/collections to insurance companies as an out of network provider
- Working knowledge of the insurance industry (Medicare, Medicaid, and commercial billing) and medical terminology
- Experience in collections/appeals a must
- Must possess a keen attention to detail
- Possess excellent customer service skills and communication (verbally and written) skills
- Medisoft knowledge preferred
Skills and Competencies
- Ability to prioritize multiple tasks.
- Proficient in Microsoft (i.e. Outlook, Word, Excel, etc.)
- Self-motivated and able to work as a team as well as independently
- Negotiation skills.
- Ability to calculate figures and amounts, apply concepts of basic algebra.
Please submit your application through our website (under office/administrative opportunities):