American National Standards Institute (ANSI), Billing, Claims Management, Claims Processing, Current Procedural Terminology (CPT), Electronic Data Interchange (EDI), High School Diploma, ICD-10, Insurance, Insurance Claims, Medical Billing, Medical Terminology, Metrics, Systems Maintenance, Time Management, Trend Analysis
- Maintains productivity and accuracy metrics per department expectations.
- Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
- Reviews insurance rejections to determine next appropriate action steps and obtain necessary information to resolve any outstanding rejections.
- Correct and identify billing errors and resubmit claims to insurance carriers.
- Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
- Assist in identifies and communicating trends and/or potential issues to management team.
- Payer website user access maintenance.
- Responsible for system maintenance of Athena master files including referring provider information, accurate insurance plan information and payer enrollments.
- Responsible for EDI, ERA and EFT enrollments for all payers.
EDUCATION
- High school diploma or GED
EXPERIENCE
- Minimum two to three years of experience in medical billing. Experienced candidates will have prior experience working claim errors in a claims management system. Prefer candidates with knowledge of ERA/EFT enrollment as well as ANSI formatting.
REQUIREMENTS
- Requires demonstrated knowledge of revenue cycle applications. Prefer prior experience configuring revenue cycle vendor-supplied software.
KNOWLEDGE
- Knowledge of ICD-10, HCPS, and CPT codes, medical terminology, and billing practices.
- Advanced computer knowledge, including Window based programs.
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Center for Orthopedic Research and Educa