Medical Biller - Revenue Cycle Specialist

Part-time or full-time positions available

In-office - Hybrid - Remote positions available

POSITION OVERVIEW:

MUST HAVE 2 YEARS MINIMUM OF HOSPITAL IN-PATIENT AND OUT-PATIENT BILLING/ COLLECTION EXPERIENCE.

Reporting to the Client Operations Manager, the Revenue Cycle Specialist Biller must have strong knowledge of medical collections, accounts receivables, insurance billing and verification, denial processing, appeal submission and EOB review. This position is responsible for resolving outstanding in-patient and out-patient facility claims.

Verify validity and collectability of the balances of each account.

Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers to obtain maximum reimbursement.

Identify whether the Accounts that contain payments were paid correctly and rebill Accounts that have not paid correctly.

Manage daily work queue to prioritize high dollar claim balances.

Review & work incoming insurance and patient correspondence, including refund requests.

Send appeals when appropriate and/or provide the requested medical documentation.

Review Accounts referred for technical detail (i.e., untimely, no authorization, billing errors, missing documentation, contractual or non-covered services,) and resolve/disposition each such Account with Payer payment reclassification (patient responsible or appropriate provider fault disposition.)

Ability to review medical documentation to justify medical necessity.

Review for clinical (detail i.e., medical necessity, place of service, or coding issues.)

Review for clinical appeals, coding edits and rebill each case when appropriate, per contract between provider and payer.

Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules, or summary plan documents.

Leverage knowledge of Medicare, state Medicaid, HMO plans, and local coverage determinations (LCD's) for claim resolution.

Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.

BENEFITS:

Up to $32.00 per hour depending on experience

Health, Dental & Vision Insurance offered

Paid Vacation/Sick/Personal Time

401K