JOB DESCRIPTION OVERVIEW:
This position is responsible for reviewing claims rejected due to a provider or claims issues. Maintains accuracy and production to ensure invoices are being processed efficiently.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
§ Reviews ETM task list assignment, comments, and processing specific provider-related denials.
§ Reviews denials to determine appropriate action based on carrier requirements.
§ Identifies and reports provider termination/enrollment issues per policy guidelines.
§ Identifies and reports carrier-specific claim issues per policy guidelines.
§ Assembles and forwards appropriate documentation to the senior representative for provider and carrier-related issues.
§ Reviews carrier provider manuals for billing updates as needed and reports these updates to the Senior/Supervisor.
§ Reports any consistent errors found during the review that affect claims from being processed correctly.
§ Participates in department meetings with the Accounts Receivable Team
§ Turns to Senior/Supervisor for unusual circumstances that may include write-offs, fee schedules, claims, etc.
§ Performs all duties as directed by Supervisor, and Accounts Receivable Manager
EXPERIENCE / SKILLS:
§ 1-2 years of previous medical billing experience required with an emphasis on research of provider and/or claims-related issues. Knowledge of physician billing policies and procedures
§ Computer literate
§ Ability to work in a fast-paced environment
§ Excellent organizational skills
§ Ability to work independently
EDUCATION:
§ High school diploma or equivalent.
