Billing, Claims Processing, Communication Skills, Customer Support/Service, Documentation, Financial Management, Financial Services, Infection Control, Insurance, Insurance Claims, Medical Billing, Patient Follow-up, Policy Development, Procedure Development, Process Improvement, Record Keeping, Reimbursement, Safety/Work Safety, Team Player, Time Management, Trend Analysis
Duties and Responsibilities
Essential Functions:
- Conducts timely follow-up on patient accounts billed to insurance companies to determine reasons for delayed or missing payments.
- Investigates denied or rejected claims, reviews insurance remittance advice, and identifies reasons for denial.
- Collaborates with insurance carriers, internal billing teams, and other stakeholders to obtain necessary information and documentation to resolve claims.
- Documents findings and actions taken to resolve denials or delays in payment.
- Initiates and manages appeals or resubmissions of denied claims as appropriate.
- Communicates effectively, verbally and in writing, directly with payors to follow up on outstanding claims, files technical and clinical appeals. Resolves payment delays/non-payments to ensure timely and accurate reimbursement.
- Maintains accurate records of follow-up activities and payment status in the billing system.
- Identifies trends in denied claims and recommends process improvements to reduce denials and expedite payment.
- Provides excellent customer service to patients and internal teams regarding billing inquiries and insurance follow-up.
Common Expectations:
- Maintains appropriate records, reports, and files as required.
- Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
- Participates in educational programs and in-service meetings.
- Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.