 Handling several Clients/Providers.
 Checking eligibility and benefit verification.
 Follow up on unpaid claims within standard billing cycle timeframe through Calls.
 Research and appeal on denied claims.
 Answer all insurance telephone inquiries pertaining to assigned accounts.
 Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid
 Call insurance companies regarding any discrepancy in payments if necessary
 Analyzes and resolves EDI claim rejections and denials related to coding issues/Patient information.
 Identify and bill secondary or tertiary insurances.
 Reviews health record documentation, Superbill, computer generated reports and other reporting tools to identify all services and procedures performed by Clients.
 Assigns appropriate ICD-10 diagnosis codes selecting the codes that accurately describe the condition for which the service or procedure was performed.
 Prepares paper and electronic claims for submission to the appropriate payer.
 Obtains and submits copies of medical documentation as required or requested by third party payers.
 Identifies services and procedures provided but not adequately documented in the health record. Advises Office Manager and Client of documentation deficiencies.
 Identifies trends and ongoing problems related to medical documentation and recommends possible solutions.
 Answers patient questions, identifies and resolves patient billing complaints
 Evaluates patient financial status and establishes payment plans
 Obtain referrals and pre-authorizations as required for procedures.
 Review patient bills for accuracy and completeness and obtain any missing information
 Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
 All accounts are to be reviewed for insurance or patient follow-up
 Other duties as advised by the Team Lead/Manager.