Job Description

Handling several Clients/Providers.

Checking eligibility and benefitverification.

Follow up on paid and 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 stateMedicaid

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 insurances.

Reviews health record documentation computer generated reports and other reporting tools to identify all services and procedures performed by Clients.

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.

CureMD is a medical billing company. We are working behalf of the US doctors and I am as a AR and i know about Follow-up, Paid, in process and denial information and if the claim has been denied so how we can fixed the denial.

Am the CSE in this company.