Responsible for obtaining appropriate reimbursement for Accounts receivables for professional services of patients seen in all types of locations while maintaining timely claims submissions. Registers patients and completes necessary documentation including insurance verification and benefits determination. Research charges to submit to appropriate carrier according to Federal/Managed Care rules, regulations and compliance guidelines. Review codes using CPT, ICD10, HCPCS and CCI guidelines to ensure compliance with institutional compliance policies for coding and claim submission. Enter and bill professional charges into automated billing system
program. Utilize resources and tools in the resolution of invoices following company policy for assigned payor/s. Resolving outstanding balances with internal and external communication with customers.
Determine appropriate action and complete action required to obtain reimbursement for all types of professional services by physicians and non-physician providers maintaining timely claims submissions and timely Appeals process as defined by individual payors.
Complete correspondence inquiries from payors, patients and/or clinics to provide the needed information for claims resolution.
Respond and send emails to all levels of management in the Business Groups, Cash Posting Department, Refunds Department, Managed Care, Clinics or CDQ to resolve coding and billing issues. Send follow up emails to ensure all necessary action is taken.
Make outbound calls, written or electronic communications, web portals and or websites to insurance companies for status and resolution of outstanding claims.
Review and interpret electronic remits and EOBs to work insurance denials and to determine appropriate insurance adjustments and obtain adjustment approvals as outlined in the company policy.
Verify and/or assign key data elements for charge entry such as, location codes, provider #s, authorization #s, referring physician and etc.
Re-file insurance claims when necessary to the appropriate carrier based on each payors specific appeals process with the knowledge of timelines.
Research, respond and take necessary action to resolve inquiries from PSRs, Charge Review and Refund Department requests.
Follow-up via professional emails to ensure timely resolution of issues.
Must be comfortable speaking with payers regarding procedure and diagnosis relationships, billing rules, payment variances and have the ability to assertively set the expectation for review or change.
Review and facilitate the correction of insurance denials, charge posting and payment posting errors.