PURPOSE STATEMENT:

Responsible for accurate, timely and complete documentation regarding insurance verification, billing and collections. 

Primary Function: Responsibilities include:

• Provides education and support to team as per guidelines and recommendations of Assistant Director
• Troubleshoot claim denial patterns and develop training material for all teammates.
• Ability to master multiple patient accounting systems and serve as subject matter expert on applications.
• Serve as back up to Assistant Director in performing month end close tasks and daily operations.
• Demonstrate consistent application of core values and vision in written and verbal communication at all times.
• Must have extensive working knowledge of Medicare and Medicaid Billing requirements, Pennsylvania Fiscal Intermediary, Novitas DDE preferred.
• Review and analyze claims for appropriate coding
• Perform follow up on unpaid claims to ensure timely resolution and payment while adhering to payor guidelines. Must have strong ability to take corrective measures to have claims reprocessed.
• Must have a solid understanding of billing processes from front end to back end and be aggressive with follow up on denials and appeals.
• Identifies deductible, co-insurance and co-pay due per EOBs received
• Compiles appropriate information for refunds, bad debt write-offs, and adjustments
• Types, assembles, copies, files and processes data required in an accurate and timely manner.
• Identifies, documents and communicates denial trends to management.
• Making telephone calls, writing letters, and/or sending faxes to patients, insurance carriers, and other responsible parties in the pursuit of getting a claim resolved.
• Handling and interpreting medical documentation such as UB04 claim form, 1500 claim forms and EOB’s.
• Analyzing and interpreting documents, contracts, notes, and other correspondence
• Writing appeals to insurance carriers to overcome denials.
• Manage an extensive portfolio of claims by prioritizing and organizing time effectively
• Must be able to work independently with minimal direction
• Comply with privacy laws and patient’s needs.
• Overcome obstacles by using effective information gathering and problem solving methods.
• Participates in monthly AR reviews with Management Team.

Education/Training/Experience:

High School graduate or equivalent required.  7 years of related experience and/or training: or equivalent combination of education and experience is required.  Prior team lead / supervisory experience is preferred. Certified CPT coder is a plus.

 Medicare and Medicaid experience is required. Recently held a position as Medicaid or Medicare Billing Coordinator or Collection Specialist is preferred. Must be able to work independently with minimal supervision. 

Computer savvy: Microsoft Excel, Microsoft Work, Clearinghouse application and solid 10-key and mathematical skills is required.  Knowledgeable in medical practices and procedures as it relates to the laws, regulations, and guidelines pertaining to HIPAA is required.  Ability to work with minimal supervision in a busy office setting is required. 

We are committed to providing equal  employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.