Essential Function:

• This position will be responsible reviewing and analyzing inactive claims and denials to perform the appropriate treatment necessary for reimbursement
• Review and analyze inactive claims and denials to perform the appropriate treatment necessary for reimbursement. Communicate directly with the Payor, via telephone as applicable, and take corrective measures to have claims reprocessed. File appeals with Payor in a timely manner and follow up to ensure receipt and processing.
• Manage daily work queues and assignments to meet department and/or Client requirements.
• Correct and verify insurance information using various eligibility online portals or other tools.
• Must be familiar with both Commercial/Medicare/Medicaid insurance plans and understand billing process from front end to back end and be aggressive with follow-ups for denials with a working appeal process in mind.
• Must have excellent verbal and written communication skills in order to effectively interact with Payors and other team members.
• Identifies, documents, and communicates trends in recurring denials and recommends process improvements or system edits to prevent future denials.
• Work with management in identifying, researching, and resolving issues which may lead to inaccurate or untimely filing of claims, claim rejections, and/or other billing and collections issues which may arise.
• Must maintain 95% quality rate based on audit criteria. Achieves goals set forth by supervisor regarding error-free work, transactions, processes and compliance requirements.
• Communicate Client/Vendor/Payor trends to Supervisor as applicable.
• Ability to handle multiple priorities at one time, ability to work independently with minimum of supervision and ability to manage and prioritize work queues and paperwork accurately under pressure of Client deadlines.
• Participates in staff meetings, trainings, and conference calls as requested and/or required.
• Maintains strict patient and provider confidentiality in compliance with all federal, state, and hospital laws and guidelines for release of information.
• Track changes within the industry to ensure a current understanding of medical terminology and coding including CPT's and ICD-10 codes.
• Reliable, consistent attendance is a requirement and essential function of this position.
• Perform other duties as may be assigned.

Competencies:

• High School Diploma or GED, College degree or completion of vocational program preferred.
• At least two years of experience in medical billing, preferably focused in denials management.
• Thorough knowledge and understanding of medical EOB’s, patient deductibles and co- pays, and insurance or third party correspondence, contractual payments and adjustments.
• Extensive experience with Medi-Cal.
• Extensive knowledge on use of email, search engine, Internet; ability to effectively use payer websites and payment gateway; knowledge and use of Microsoft Products: Outlook, Word, Excel. Preferred experience with various billing systems, such as Raintree and Lytec.

10282020