Responsible for ensuring that unpaid and partially paid claims are resolved in an efficient and timely manner. Resolves EOB discrepancies and researches refunds. Monitors and ensures that collections, net, gross and days in accounts receivable targets are met.
Duties and Responsibilities:
1. Follows up on submitted claims, monitors unpaid claims and resubmits claims with appropriate corrections and documentation.
2. Works declines and processes appeals.
3. Ensures that established billing targets for collections, gross, days in A/R and net collection ratios are met.
4. May analyze claims system reports to ensure that underpayments are correctly identified and collected from key carriers.
5. Works with payer and provider representatives to negotiate higher rates for claim payments.
6. Responds to patient and third party inquiries, researches and resolves complex claims and corrects errors.
7. Reviews correspondence and rejection data from insurance carriers; posts rejections and performs reconciliations.
8. May transfer secondary balances to appropriate financial class and provide documentation for processing the claims.
9. Reviews Credit Letter Sent (CLS) and transfers balance to appropriate financial class and dunning level.
10. Reviews, works and clears electronic and claims edits daily; summarizes and forwards non-workable edits to supervisor for resolution.
11. May process refunds for supervisory approval.
12. Prepares and submits referring physician updates and other major dictionary requests to supervisor for approval.
13. Mentors less experienced staff and assists Billing Manager with the training of new hires.
14. Maintains strictest confidentiality; adheres to all HIPAA and Federal Payor guidelines and regulations.
15. Performs other related duties
Associates Degree or HS Diploma/GED plus two years of related experience.
3 years healthcare billing experience required. Familiarity with CPT and ICD (coding and CCI edits).
Electronic claims processing preferred.
Mount Sinai Medical Center is an equal opportunity/affirmative action employer. We recognize the power and importance of a diverse employee population and strongly encourage applicants with various experiences and backgrounds.
Mount Sinai Medical Center--An EEO/AA-D/V Employer.
Mount Sinai Medical Center