Skills

Billingunmatched

Contract Managementunmatched

Denials Managementunmatched

Diagnosis-Related Group (DRG)unmatched

Document Imagingunmatched

HIPAA (Health Insurance Portability and Accountability Act)unmatched

Healthcare Common Procedure Coding System (HCPCS)unmatched

Hospitalunmatched

Hospital Systemsunmatched

ICD-10unmatched

Information Technology & Information Systemsunmatched

Insuranceunmatched

Medical Recordsunmatched

Problem Solving Skillsunmatched

Resolve Customer Issuesunmatched

Team Playerunmatched

Time Managementunmatched

Description

Ensure account accuracy.
Review daily claims to ensure submissions are clean and timely.
Monitor charges/modifiers/CPT-4s/HCPCS/payments/DRGs/ICD-10 coding.
Review outstanding accounts using ATB/queues/payments reports/halt report/electronic billing edits/credit balances.
Submit timely and accurate adjustments/notes/patient balance transfers and medical record requests.
Work with management team and notifying of notifying of issues that arise with payors/departments/etc
Resolve account issues and problem solving independently whenever possible.
Use technology provided (including hospital information system, contract management system, electronic billing system, payer websites and document imaging system.)
Manage denials and appealing administrative claims.
Understand denials and how they should be handled.
Send clinical denials and downgraded claims to appropriate parties to ensure timely appeal.
Ensure claims denied at time of billing are distributed to appropriate parties for review.
Update and correct accounts with assistance of originating departments (charges/authorizations/insurance issues).
Follow departmental and hospital policy and procedure (this includes HIPAA guidelines and Federal guidelines).
Understand payor contracts and billing guidelines; revenue codes and payor specific requirements; and payor/plan codes.

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