Job Description
The Billing Claims Specialist, Accounts Receivable plays a critical role in integrating billing and revenue best practices in response to payor adjudication for the contracted, non-contracted, government payor groups. This position focuses on claims processing, accounts receivable management, and handling low pay claims, denials, expect to pay discrepancies, appeals, and other various tasks related to accounts receivables. The successful candidate will ensure accurate billing, timely reimbursement, and compliance with industry standards.
Essential Functions
Answer and direct phone calls.
Research and appeal denials in a timely manner
Keep desk current as time frame deemed appropriate by manager, reach daily KPIs.
Complete designated Error Processing and reject reports in a timely manner.
Correspond with patients and insurance companies
Process all denials, rejections, priority HMO's, and insurance with short timely filing limits
File appeals and contact payers to fruition
All other duties as assigned
Job Requirements and Skills
3+ years of medical billing experience (Pathology billing experience is a plus)
High school diploma
Advance knowledge of PPO, HMO, IPA, CMS, Managed Medi-caid/Managed Medicare
Working knowledge of CPT/ICD Codes
Knowledge of eligibility and benefits
Detail-oriented and ability to demonstrate a positive and proactive attitude
Ability to work cooperatively with others in a team environment
Self-starter with solid organizational skills and ability to effectively manage multiple priorities or reprioritization of projects
Excellent written and verbal communication skills
Documentation skills, ability to research and resolve issues
Ability to multi-task with a results-oriented paradigm in a fast-pace, high volume environment
Ability to read and interpret EOB's
Proficient in Microsoft Office Suite - Strong Excel and Word skills are required