PURPOSE STATEMENT:
Responsible for accurate, timely and complete documentation regarding insurance verification, billing and collections.
ESSENTIAL FUNCTIONS:
Responsible for verification and interpretation of insurance benefits and establishing financial arrangements with guarantor/patient.
Estimate patient out-of-pocket and make financial arrangements with guarantor/patient. Post payment and follow up with claims.
Prepare and review all billing forms to ensure accuracy and completeness for claims submission to insurance carriers and back up for Medicare and Medicaid claims.
Process claims electronically or hard copy with 100% accuracy and mail claims to insurance carriers timely.
Enter documentation and adjustments through computer system to maintain a correct account balance.
Update system information according to correspondence received and processed. Document any changes and submit to appropriate staff.
Review charge summaries on each patient bill that is produced and identify discrepancies with 100% accuracy.
Consistently apply appropriate procedures to prevent accounts from becoming delinquent or remaining unbilled.
Initiate appropriate follow-up and collection calls.
Review remittance advice statements for payments and adjustments on a daily basis and initiate appropriate data entry for patient charge or account discrepancy on review.
Identify denial and pending reasons and investigate, resolve and initiate information to secure reimbursement.
OTHER FUNCTIONS:
Perform other functions and tasks as assigned.
EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:
High school diploma or equivalent required. Must have at least 3 years' experience in related field. Must have extensive knowledge and understanding of Commercial Insurance and Medicare/Medicaid.
Experience
Required
3 year(s): Must have at least 3 years' experience in related field. Must have extensive knowledge and understanding of Commercial Insurance and Medicare/Medicaid.
Education
Required
High School/GED or better
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)
