Overview
This role involves managing billing, collections, credit, payments, and reconciliations within a healthcare setting. Responsibilities include manual re-bills and electronic claim submissions to payers, as well as follow-up activities such as telephone calls to payers and patients, accessing payer websites, and resolving complex accounts with minimal assistance.
Remote positions are available, but hiring decisions may be influenced by the applicant's state of residence. Currently, remote hiring is open in the following states:
- Alabama
- Arizona
- Florida
- Georgia
- Idaho
- Indiana
- Kansas
- Michigan
- Missouri
- North Carolina
- Ohio
- Oklahoma
- Pennsylvania
- South Carolina
- Tennessee
- Texas
- Virginia
Responsibilities
Billing
- Edit and submit claims to insurance clearinghouses via electronic or paper methods.
- Determine when claims require auditor or coder review for corrections.
- Review rejected claims, make necessary corrections, and resubmit to payers.
- Maintain communication regarding updates to CPT and ICD-10 codes.
- Collaborate with the Billing Manager to maximize revenue potential for services and providers.
Claim Follow-Up
- Manage denied claims by correcting and editing through work queues, correspondence, and emails. Common issues include invalid CPT or diagnosis codes, missing modifiers, billing another carrier, invalid eligibility, authorization/referral issues, and documentation requirements.
- Document encounter notes related to rejections and follow-up activities to maintain claim history.
- Perform account adjustments or write-offs in accordance with the organization's write-off policy.
- Communicate internally with health centers regarding insurance billing and collections.
- Request medical records from health centers as required by contracted insurance plans.
- Correspond and assist vendors involved with patient accounts.
Compliance and Safety
- Report any safety-related incidents promptly using designated tools.
- Attend all safety training programs and perform work safely.
- Monitor the work environment for safety issues and ensure others comply with safety practices.
- Maintain confidentiality of all department, patient, and billing information.
- Complete all mandatory company training modules and job-specific training within required timeframes.
- Stay current with and comply with state and federal regulations, statutes, and company policies relevant to the role.
Qualifications
Education
- High School Diploma or GED (required)
Experience (Preferred)
- Medical insurance billing and collections
- Medical or hospital billing
- Knowledge of UB04 billing form
- Understanding of Explanation of Benefits (EOB)
Skills
- Proficiency with computers and basic software programs is required due to the integration of technology in patient care and billing processes.
Location
Remote work is available in select states as listed above. Hiring decisions may depend on the applicant's state of residence.