POSITION SUMMARY

Responsible for timely accurate billing, and payment of third-party claims.  The Representative is responsible for reporting exceptions, weekly reports of unbilled accounts, and for a complete working knowledge of coverage and types of insurance with which the Representative works.

PRIMARY  DUTIES:

• Prepares appropriate claims for insurance companies, including specific supporting documentation, forms and authorization.
• Processes insurance payments and bills second insurance carrier if applicable.  Investigates questionable insurance payments and follows up with patient and/or payor until claim is resolved.  Prepares adjustment write-off for non-covered charges.
• Work with clinic office staff to resolve claim denials, investigate pre-authorizations, or obtain other necessary documentation. 
• As necessary, researches credit balances and processes refunds to insurance companies for overpaid accounts.
• Obtains required insurance information from patients.  Monitors the status of accounts pending requested information, completes follow up with the patient or insurance carrier until the claim is paid.
• Completes follow up each month according to accounts listed on the aging selection file report.
• Reviews correspondence, manual revisions, newsletters and  payor websites to keep abreast of changes in insurance, Welfare, and Medicare coverage provisions and billing requirements.
• Receives and responds to inquiries from patients, insurance companies, Medicare, Medicaid and other third parties regarding patient accounts.
• Reviews itemized statements and insurance billing forms produced in-house to insure quality and accuracy. Claims that require proration, non-covered, or claim fixes are given to the Supervisor to fix.
• Prepares, files and records accurate medical liens for accident claims that may be covered by automobile insurance or a homeowners policy. Completes and files amendments and releases as necessary.
• Reviews daily payment report to assure proper application of insurance payments.
• Investigates third party liability claims; follows up for proper billing information and payment. Works with attorneys or their representatives to resolve claims.
• Responsible for proper handling and logging of medical records according to HIPAA and Medical Center Policy.
• Reviews weekly patient balance report to insure proper mailing of self-payment statements.
• Demonstrates a commitment to the key values of Service to the Poor, Reverence, Integrity, Wisdom, Creativity and Dedication.
• Working with various vendors on reconciliation of the file placements. 
• First point of contact for all vendors. Responsible for maintaining issue logs and working all accounts assigned. Can include updating insurance, rebills, adjustments, refunds, close and return accounts. 

The above statements reflect the general duties considered necessary to describe the principal functions of the job as identified, and shall not be considered as a detailed description of all the work requirements that may be inherent in the position. Performs other related duties as assigned. 

LICENSE, EDUCATION & EXPERIENCE

Required:

• High School Diploma or equivalent 
• Ability to detect and correct billing errors, knowledge of ICD and CPT/HCPCS coding systems, skill in mathematical computations.
• Analytical skills, a high degree of accuracy and attention to detail. 
• Problem-solving skills and the ability to adapt to changing procedures are necessary
• Strong written, verbal and interpersonal skills. 
• Must be able to organize work efficiently and document billing procedures. 
• Must be competent in the use of a personal computer and spreadsheet and word processing software, fax machine, scanner and copier.

Preferred:

• Medical Secretary or Associate degree.
• Job related experience in medical billing and/or insurance claims processing
• Knowledge of Medicare, Medicaid and insurance coverage and billing regulations.