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QUALIFICATIONS
Education
- High school graduate or equivalent
Experience/Skills
- Athena experience preferred
- Possesses knowledge of business office operations
- Understands third party billing requirements
- Understands Medicare/Medicaid inpatient and outpatient billing
- Strives for customer satisfaction when responding to all patient/customer inquires (internal customers)
- Experience using office equipment
- Adapts professionally to changes in procedures and/or workload
- Possesses excellent written and oral communication skills
- Works independently with little supervision
- Maintains concentration
- Remains committed to a “cross training” philosophy for all assigned tasks
Working Conditions
- Works in a well-ventilated, well-lit general office environment
- Works well under pressure with attention to time constraints
ROUTINE RESPONSIBILITIES
Behavioral Expectations
- Consistently complies with established Behavioral Expectations
Essential Duties
- Reviews, identifies, and corrects claims issues identified in inhouse hold and the claim scrubbing holds
- Sends clean, timely claims out on first billing
- Works reconciliation desktops to ensure upfront rejection of claims are processed and resubmitted to correct payer
- Reviews assigned outstanding accounts receivable by using ATB, queues, and payment reports
- Submits timely and accurate adjustments documenting activity in account
- Understands and manages denials, submitting timely disputes and appeals
- Follows up with insurance companies to ensure claims are processed and paid correctly according to contract
- Understands payor contracts and billing guidelines. revenue codes, cpt codes, modifiers, and payor-specific guidelines
- Investigates and reports claims denial trends with payer documentation for departments to review and establish action plan
- Provides back-up phone support to billing lines daily
Full time/Day shift
80 hours/Biweekly
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