Reviews and audits accounts located in contract management system on a daily basis to resolve and maintain collection status on an account prior to escalating to Team Lead for further review.
Reviews and processes commercial accounts through contract management system.
Verifies eligibility, corrects and resubmits claim, and files third party insurances as necessary by adding/updating insurance information to Host system..
Utilizes contract and denial management system and responds to requests from insurance carrier for additional information necessary to process claims.
Analyzes expected reimbursement information in contract management system.
Utilizes contract management system/contract foundation to ensure the accounts are properly paid. Reviews EOB's and determines accurate account balance, detailed denial description, and applicable appeal process.
Identifies and corrects transactions, such as invalid insurance information, incorrect charges, and posting errors, in Host system. Posts adjustments in HQ system.
Reviews and verifies claim export data in electronic billing system, contract management, and/or host system.
Out of Network
No Pre-Certification/Lack of Authorization/Notification
General application knowledge of EXCEL, WORD, and ACCESS.
Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred.
3 years + working experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes strongly preferred.
Prefer at least 1 year of supervisory experience strongly preferred.
Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred.
Effective communication skills verbally and written with internal Hospital departments, Physician Offices, Patient, and Insurance payors.
Must be able to effectively manage a large volume of accounts while maintaining a high accuracy and positive outcomes.