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.