Job Description
Overview
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 non-governmental 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 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 the system/contract foundation to ensure the accounts are properly paid. Reviews EOB's in contract management system 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 host system. Reviews and verifies claim export data in electronic billing, contract management and/or host systems.
Qualifications
Minimum Knowledge, Skills and Experience required:
Education: High school diploma or GED.
Experience: 6 months to 1 year working experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes strongly preferred.
Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred.
Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred.
Additional Skills: General application knowledge of EXCEL and WORD.
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.