ESSENTIALS DUTIES AND RESPONSIBILITIES:

· Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.

· Manage daily work queue to prioritize high dollar claim balances.

· Review & work incoming insurance and patient correspondence including refund requests.

· Send appeals when appropriate or provide the requested medical documentation.

· Ability to review medical documentation to justify medical necessity.

· Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.

· Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

· Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.

· Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.

· Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.

Required Skills:

· 2+ years of revenue cycle

• Ability to read and interpret insurance explanations of benefits and managed care contracts.
• Must communicate effectively, both verbally and in writing, with internal and external clients.
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
• Knowledge or experience working with a variety of health care insurance payers is preferred.
• High School Diploma or equivalent.

Required Skills

Required Experience

General knowledge of the healthcare industry insurance/EOB payment process