Position responsible for processing, evaluating and billing Medicaid, Commercial insurance claims as well as patient pay claims. Claims denied reimbursement by the insurance company will be evaluated and processed in a timely manner, in accordance with State and Federal laws.
- Regular, punctual attendance.
- Have working knowledge of the following computer programs:
- Microsoft Word-fundamental
- Microsoft Excel-fundamental
- Microsoft Outlook-fundamental
- Read and reply to email in a timely manner as needed.
- Listen and respond to voicemail in a timely manner as needed.
- To communicate effectively with patient as required.
- Answer all incoming inquires regarding patient cases as appropriate.
- Understand their role and impact they have in the departmental team; including exhibiting positive attitudes, willingness to help wherever asked, staying focused and on task to the matter at hand, and being part of the success of your team.
- To learn and understand the billing requirements of insurance companies.
- Daily production consistently meets stated goals for job position.
- Process and bill claims to all insurance companies as well as the patient.
- To investigate and analyze insurance claims denied reimbursement by reading documents, interfacing with insurance company personnel, patients, and the patient’s physicians and/or nurses, and negotiating computer based research.
- To develop, for insurance claim denials, a reasonable patient product use detail and history; to develop and substantiate the product use evidence, and present the patients case as an appeal insurance companies.
- To perform insurance transfers, post and document insurance claim status within the billing system, and generate insurance company denied claim status-follow up in the computer system.
- To determine the necessity of a patient to be directly responsible for a portion of the claim charges not coverage by a primary or secondary insurance carrier.
- Set up patient payment arrangements.
- Validate qualification for hardship program.
- Resolve customer concerns.
- Determine and obtain prior authorization for new VAC placements as well as seek extended coverage.
- Perform other tasks as requested by Supervisor or Management Staff.
- High School Diploma or equivalent
- Effective Communication Skills
- PC Skills
- Working 10-key and/or keyboarding skills
- Proficiency in general office duties
- Ability to prioritize
- Attention to detail
- Ability to enter data accurately
- Demonstrate good interpersonal skills
- Ability to maintain complete confidentiality and discretion in business relationships
- Demonstrate willingness and ability to participate in, and complete, all required training programs
- Ability to work effectively and exercise sound business judgment in a team environment, as well as independently
- Demonstrate flexibility in work shift to meet department needs
- Demonstrate ability to deal effectively with all employees and external business contacts while conveying a positive service-oriented attitude
- Perform duties in an accurate and complete manner evaluated and validated via quality assurance assessment
- General office experience required.
- PC skills to include Excel and Word
- Ability to work in a team environment as well as independently
- Excellent telephone skills