Medical Billing Collection

Job Responsibilities / Duties

• Work assigned claim volume timely and efficiently within corporate timeframes.
• Follow all processes and procedures as set by the Training Coordinator and/or department leadership.
• Understand and stay informed of the changes in procedures, billing guidelines, and laws for specific insurance carriers or payers.
• Initiate collection follow-up on all unpaid or denied claims with the appropriate insurance carrier.
• Research, appeal, and resolve unpaid insurance claims.
• Actively follow up and collect on all claims, including the resolution of any billing errors assigned, following established procedures.
• Respond to correspondence from insurance carriers.
• Provide oversight and direction within the assigned team.
• Meet weekly with all team members via huddles or one-on-one training as approved by leadership.
• Work to identify, correct, and sustain any issues with production, workflow, and training.
• Handle escalation of issues from team members via phone, email, or in writing.
• Provide weekly updates via written reports to leadership.
• Work with the Training Coordinator and Leadership as necessary.
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.
• Perform other duties as assigned by the department manager.

Qualifications

• Minimum Education: High School Diploma/G.E.D.
• Minimum 3+ Years of experience with insurance collections and follow-up.
• Knowledge of both In-Network and Out-of-Network Facility and Physician Claims.
• Knowledge of HIPAA, healthcare regulations, and compliance.
• Positive attitude, Team player, and ability to work independently.
• Must have an understanding of Revenue Cycle, Claims Processing, and Denial Resolution.
• Prior experience working with commercial payers such as UHC, Cigna, Aetna, BCBS, Marketplace plans, and Humana.
• Experience in preparing and submitting claims, facility, physician, and specialist.
• Experience in reading, analyzing, and interpreting EOB’s from various insurance providers is a must.
• Familiarity with identifying claims in need of appeal and the appeals process.
• Ability to clearly communicate claim follow-up and appeals status with insurance company representatives.
• Demonstrates excellent problem-solving skills and negotiating skills.
• Proven experience in a production-based environment with a concentration on meeting production standards.
• Knowledge of EPower and Centricity is desired.
• Familiarity with computers and Windows PC applications such as Excel and Word, including the ability to learn new computer systems applications.
• Type 45-60 WPM.
• Prior leadership training or experience preferred.