Performs necessary functions to support timely claims processing to third party and guarantors. Contacts payers to follow-up on reimbursement of billing services provided to patients. Ensures timeliness and accuracy of payments and adjustments posted to accounts. Initiates third party appeals for reconsideration on underpaid balances.
Monitor unbilled claims report and follow up with appropriate personnel to complete information needed for bill generation
Review system generated reports to resolve unpaid claims; correct billing errors for electronic submission of bills
Validate successful transmission of claims to insurance carrier and intermediaries
Audit account history to ensure appropriate reimbursement has been received and that contractual allowances have been accurately posted
Establish reasonable payment plans according to policies; set up budget plan in system and monitor payments for consistency and timeliness
Counsel patient on various local, state and federal agencies which may be available to assist with funding health care (e.g., bank loans, Medicaid, etc.)
Initiates and/or directs assisting the patient in obtaining third party coverage (e.g., complete enrollment forms, obtain required documentation and follow up on eligibility status, etc.)
Process account balance, potential refunds, adjustments, payment transfers, etc. to bring balance to zero
High school graduate or equivalent with at least five years prior work experience in physician practice plan of hospital business office preferred or bachelor's degree with two years experience.
Ability to operate electronic claims processing system.
Must be knowledgeable regarding detailed claims preparation and payer specific billing requirements and reimbursement guidelines.
Must have a good understanding of medical terminology and medical records coding, third party payer guidelines and reimbursement practices and available financial resources for payment of balances due.
Must demonstrate excellent interpersonal, organizational, and communication skills.
Must be able to communicate with patients, payers, outside agencies, and the general public through face to face, telephone, and written correspondence.