Out Of Network-Ar Specialist

National Neuromonitoring San Antonio , TX 78205

Posted 2 weeks ago

This position is responsible for the resolution of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.



  • Reviews medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed
  • Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation
  • Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information
  • Responsible for working claim rejections in a timely manner
  • Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Able to apply correctly to claims/ fee billed
  • Processes incoming EOBs to ensure timely insurance filing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance
  • Responsible for processing payments, adjustments, and denials according to established guidelines
  • Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts
  • Responsible for reconciling transactions to ensure that payments are balanced
  • Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures
  • Responsible for keeping current with changes in their respective payer’s policies and procedures

Required Qualifications:

  • High school diploma or GED equivalent
  • Two or more years of relevant experience in the healthcare industry, with a focus on medical terminology and ICD/CPT coding preferred
  • Strong attention to detail and professional customer service skills
  • Intermediate level with Microsoft Office applications

Preferred Qualifications:

  • Knowledge of submission and re-submission of medical claims
  • Government and commercial policies and procedures knowledge.
  • Knowledge of ICD, CPT codes and HCPCS coding
  • HIPAA compliance rules and regulations
  • Skill in the operation of billing software and office equipment
  • Skill in processing claims efficiently and on a timely basis
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Out Of Network-Ar Specialist

National Neuromonitoring