Develops and implements an action plan for processing and resolution of all insurance accounts. Is knowledgeable of third party payer requirements in order to expedite payment of accounts. Responsible for processing and following up with insurance payers on healthcare claims in a timely and efficient manner, to maintain cash flow in support of the mission and goals of the ambulance billing office. Position requires high level of customer service skills to establish and enhance positive relationships with our insurance contacts, third party payers, co-workers, departments and others.
ESSENTIAL DUTIES AND Responsibilities:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
? Follows up with insurance payors, as assigned, on unpaid claims; makes appeals, requests medical reviews as needed, and reviews reimbursement daily. Uses both websites and calls as available.
? Reviews and takes appropriate action on all correspondence received for assigned state or payor. Turnaround of 24 hours required, up to 72 hours as an exception.
? Works payor rejections daily as provided on MREP (Medicare Remit Easy Print) including Medicare or any other payors populating in this file.
? Works assigned workflows for any category of unpaid claims, including rejections posted.
? Watches for trends in rejections codes/comments and reports to Supervisor.
? Looks for accurate collection of payment (contractual and non contractual according to fee schedules). Reports as necessary.
? Works with Coders to review trip runs to ensure medical diagnosis support reason for transport daily. Reports any diagnoses updates.
? Provides billing support to management and operational staff by staying abreast of assigned state or payor insurance regulation updates and by keeping them informed.
? Assesses discounts and requests payments for private (commercial) payors.
? Assists with the submission of billing data via hard copy and electronically. Works with EDI specialist as needed.
Obtains and submits copies of medical documentation to support billing to third-party payors as required.
Billing Specialist A/R Follow-Up:
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? Identifies transport service provided, but not adequately documented in the medical record. Advises supervisor of deficiencies to support charge capture of all billing services.
? Resolves a minimum of 40 accounts a day; an average of 320 weekly.
? Collects revenue to achieve and exceed operational/Receivables goal.
? Ensures HIPAA compliance with regard to billing practices.
? Generates monthly reports as requested.
? Continuously cross-trains in other function areas.
? Takes calls from payors or patients generated by notification letters. Assist with any Billing Office calls as needed.
? Other duties as assigned.
KNOWLEDGE, SKILLS & ABILITIES
? Thorough knowledge of ambulance transport documentation.
? Extensive knowledge of ICD-9 and Condition Codes.
? Ability to collect for healthcare claims from MCR/MCD, commercial insurance, contracted facilities, and individuals.
? Understands Medicare and Medicaid regulations and guidelines.
? Familiarity with Medicare, Medicaid, Coding, Private Pay, and insurance preferred.
? Familiarity with medical terminology.
? Ability to interpret EOB (Explanation of Benefits)
? Familiarity with Microsoft Office Suite
? Working knowledge of RightCAD database