Overview
This position, reporting to the Revenue Cycle Supervisor, is responsible for managing the timely collection of accounts receivable and maximizing reimbursement for physician billing. The role requires monitoring account activity, handling insurance follow-up, and managing denial resolution in a fast-paced healthcare setting.
Responsibilities
- Conduct collection activities including status calls, appeals, and account reviews to ensure prompt reimbursement.
- Research and resolve claim denials using internal and external resources.
- Monitor denied claims to ensure timely corrections or appeals.
- Review pre-bill claim holds to ensure clean claim submissions.
- Submit accurate information to insurance companies to expedite payments.
- Take proactive follow-up actions to secure payment on the first call or appeal when possible.
- Compose and submit appeals for denied claims to insurance carriers.
- Correct claims billed to incorrect insurance carriers and ensure authorizations are attached.
- Respond to insurance company information requests within 24 hours.
- Assist Financial Counselors with patient inquiries related to insurance claims.
- Collaborate with internal business office teams to resolve billing and reimbursement issues.
- Communicate trends, issues, and findings to leadership and management.
- Meet productivity, quality, and performance standards set by management.
- Comply with all company policies and procedures.
- Perform other duties as assigned.
Requirements
- High School Diploma or GED required.
- 2 to 4 years of experience in physician office billing and denial management.
- Working knowledge of ICD-10, CPT, and HCPCS coding.
- Ability to read and interpret Explanation of Benefits (EOBs).
- Knowledge of Medicare Part B, Medical Assistance, and commercial insurance products.
- Familiarity with CMS-1500 claim forms.
- Basic understanding of medical terminology and anatomy.
Preferred Qualifications
- Experience with Athena billing system strongly preferred.
- Excellent written and verbal communication skills.
- Strong attention to detail with the ability to multitask and work independently.
- Proficient in Microsoft Office Suite and general computer applications.
- Ability to work effectively in a fast-paced, growing practice environment.
- Self-starter with strong organizational and problem-solving skills.
Additional Information
This organization maintains a drug-free workplace. Candidates will be required to undergo pre-employment drug screening and may be subject to random drug testing in accordance with applicable laws and company policy.