Medical Insurance Accountant (Medical Biller)

Position:

We are looking for a Medical Billing Coordinator to join our administrative team to process patient billing information.

A Billing Coordinator’s responsibilities include tasks that require data analysis and sound judgment to help process insurance claims. In addition, the best candidate for this position will be experienced with billing software and medical insurance policies. Ultimately, you will demonstrate excellent written and verbal communication skills, which are necessary when working with clients or agents who regularly deal in these matters.

Duties and Responsibilities:

• Review and verify patient insurance information
• Prepare and submit accurate claims to insurance companies electronically or by paper
• Resolve billing issues and discrepancies
• Perform cash posting for daily cash and insurance payments
• Work Patient Accounts Receivable and update patient files accurately and effectively with all collection activities.
• Discuss all issues with the Accounts Receivables Supervisor regarding any concerns or problems with payment posting.
• Research payer denials related to referral, pre-authorization, medical necessity, case management, non-covered services, and billing resulting in denials and delays in payment. Initiate appeals with insurers appropriately.
• Submit detailed, customized appeals to payers based on review of medical records and in accordance with Medicare, Medicaid, and third-party guidelines.
• Serve as a resource for clinical case management departments regarding concurrent denials
• Coordinate appropriate status determinations using Ensemble Therapy Guidelines and Medicare guidelines
• Identify denial patterns and escalate to management as appropriate with sufficient information for additional follow-up, and/or root cause resolution
• Make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials
• Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and leadership as appropriate.
• Maintain patient confidentiality and adhere to all HIPAA regulations.

Knowledge, Skills, and Requirements:

• Proven work experience as a Medical Biller or similar role
• Proficient understanding of billing software and electronic medical records
• Must have the ability to multitask and manage time effectively
• Excellent written and verbal communication skills
• Outstanding problem-solving and organizational abilities
• Reliable Internet Network for remote job functions.