Medical BillerCollector

This position will perform collections and medical billing for various regional and national payers including Federal State Third Party (HMO PPO IPA TPA Indemnity) and Patient Billing. Qualified candidates must be able to (1) Review accounts for billing accuracy in order to maximize reimbursement. (2) Persuasive and tenacious follow-up on claims status (3) Appeal and re-bill or forward claims for recalculation and / or adjudication as necessary. Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal State PPO HMO and Indemnity Plans structure. Must meet or exceed the standard level of performance on assigned accounts.

ESSENTIAL RESPONSIBILITIES:

Data entry correct insurance assignment to patient accounts insurance eligibility verification. Review/update demographics and patient information for accuracy.

Working knowledge of appropriate coding systems; CPT ICD-9 and HCPCS coverage; LCD/NCD and reimbursement associated with such codes.

Processing validation of payer requests and processed claims via correspondence remittance advice and EOBs (i.e. identification of payment discrepancies inappropriate requests)

Investigate all denied services to determine the reason for the service denial appeal if appropriate. Identify report root causes associated with denials

Timely effective processing of assigned appeals including development submission tracking reporting and evaluation of appeal outcomes (i.e. next steps improved outcomes)

Maximize utilization of Billing system tools and resources to support cash collection activities.

Review and work various reports including aging adjustments and credit balances.

Comply with Federal and State legislation pertaining to all billing related matters.

Comply with all Safety Emergency Hazard OSHA HIPAA Quality Assurance and Administrative Plans Policies Guidelines Protocol and Standards.

Support and maintain department cash and DSO goals

Other duties as assigned

The above list represents the general duties considered essential functions of the job and is not to be considered an exhaustive description of all the work requirements that may be inherent in the position.

High School Diploma and a minimum of four years related experience or a Bachelors degree from a four-year college or university; or equivalent combination of education and experience

Working knowledge and prior hands-on experience of medical billing and reimbursement. Credentialing experience a plus.

Proficient in Microsoft Outlook Excel Word the Inter and Intranet and other programs/software as necessary.

Problem solving skills using good judgment attention to detail and follow-through are a must.

Excellent customer service skills; excellent verbal and written communication skills. Ability to prioritize work multi-task and time management skills.

Ability to easily adapt to increased business demands

Ability to effectively work with and resolve complex accounts & billing issues

Establish and maintain cohesive and good working relationships.

Excellent communication and customer service skills; cooperative work collaboratively and treat others in respectful professional and supportive manner.