Description

JOB PURPOSE: Position is responsible for researching and resolving outstanding claims issues to ensure maximization of claims reimbursement.

JOB FUNCTIONS:

• Monitor all payer types on unresolved claims by running appropriate reports and contacting insurance companies to resolve claims that are not paid in a timely manner outbound calls required
• Follow up on all outstanding insurance accounts 
• Research denials and requests/inquiries from insurance payers
• Retrieve supporting documentation from the hospital system for accurate and timely processing of claims 
• Possess full understanding of EOB’s to ensure payment accuracy and compliance with contract discount.
• Identifies, analyzes and escalates trends impacting AR reimbursement
• Responsible for outreach to payers to validate incomplete or invalid insurance information
• Review and recommend claims for adjustment/write off to management.
• Initiate 1st level appeals for denied claims as appropriate
• Document clear, concise and complete follow up notes in system for each account worked
• Contact third party payers and patients to expedite and maximize payment
• Work error reports in a timely manner (set by Director/Manager)
• Meet with assigned site managers as needed
• Collaborate with management to reduce aging of accounts by providing verbal and written communication 
• Demonstrates proficiency of all payers, including Medicare, Medi-Cal and commercial payers 
• Perform other related duties as assigned 

Requirements

Education:

• High school education or equivalent, with specialized training.

Experience:

• One to three years or more working specifically in professional medical billing and collections accounts receivable
• Two years’ experience using Medical Billing software and Applications 
• Experience handling confidential data i.e., patient demographic information, payor fee schedules, reimbursement rates, etc.

PERFORMANCE REQUIREMENTS:

Knowledge:

• Knowledge of current CPT-4 and ICD-10 coding. 
• Knowledge of medical terminology and health insurance billing.
• Knowledge of common insurance plans, i.e., HMO, PPO, Capitation, Medicare and Medi-cal

Skills:

• Good research skills
• Decision Making
• Analytical and problem-solving skills with attention to detail
• Strong verbal and written communication
• Excellent customer service skills
• Proficient computer skills and knowledge of Microsoft Office

Abilities:

• Ability to understand and interpret policies and procedures.
• Ability to communicate effectively and work with others.
• Ability to apply principles of analytical thinking to extract correct data from documentation.
• Ability to prioritize and manage multiple tasks.
• Solid ability to learn new technologies and possess the technical aptitude required to understand flow of data through systems as well as system interaction.
• Ability to work in a fast-paced environment

Physical Requirements:

• Involves sitting approximately 90 percent of the day, walking or standing the remainder. Some bending, stooping, and lifting up to 15 pounds.

Equipment Operated:

• Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment:

• Position in a well-lit, well-ventilated office environment. Frequent contact with a variety of people.

Safety:

• All employees are responsible for complying with safe and healthful work practices as outlined in Inspire Health’s Employee Safety and Injury and Illness Prevention Program and policies and procedures specific to their department needs.