Ridgewood, NY30+ days ago
Responsibilities: • Partners with Operations to resolve issues surrounding unbilled claims, authorizations, Physician Certification Statements (PCSs), Patient Care Reports (PCRs), and insurance, and demographic capture issues • Responsible for escalating concerns regarding questionable paperwork to appropriate management • Contact payers to verify claim status via phone or web and follow up on unpaid claims • Process appeals on aged insurance claims/denials • Analyze, identify and resolve issues which may cause payer payment delays • Identify and resolve claim edits through understanding of billing guidelines and payer requirements • Reconcile commercial and government accounts, ensuring CPT and diagnostic codes are accurate • Interpret terms for Managed Care, Commercial, Medicare, Medicaid and Workers Compensation and No Fault when applicable • Review all EOBs for correct payment, deductible, adjustments, and denials • Determining the status of claims with the insurance company, if the claim meets contractual agreements or needs adjustment • Reconcile account balances, and verify payments are applied correctly • Maintain well aged accounts, promptly resolve, and resubmit denied unpaid claims in a timely and efficient manner • Follow up on appeals/corrected submitted claims • Review and correct billing errors, which require a strong knowledge of CPT and ICD-10 coding • Review and audit customer service account inquiries • Receive inbound/outbound customer service call • Provide excellent customer service to all patients, Insurances & Facilities • Review and correct all rejections in clearing house • Perform all other related duties as assigned. Qualifications: Must have 2-3 years of medical billing experience (required) Ambulance billing experience (preferred) Extensive Medicare and Medicaid experience and understanding medical necessity in ambulance transportation Proficient in CPT and ICD-10 coding Ambulance/Medical billing certification or diploma preferred Certified Ambulance Coder (CAC) or Certified Professional Coder (CPC) preferred Excellent organizational skills and the ability to multitask in a fast-paced environment Analytical - collects and researches data; uses intuition and experience to complement data.