Performs accounts receivable functions including billing, pursuing reimbursement, customer service, and record keeping.

Key Responsibilities:

• Responsible for claim review and submission to Medicare, Medicaid, commercial and private insurance payers.  Verifies accuracy and completeness of all required information prior to submission.

• Follows up with insurance companies on unpaid or rejected claims.  Resolves issues and resubmits claims.

• Reads and interprets insurance explanation of benefits.  Maintains specialized knowledge in insurance processes and guidelines, including authorizations and limitations. 

• Investigates insurance claim denials, exceptions, or exclusions.  Takes necessary action to resolve claim and payer issues in an effort to recover proper reimbursement. 

• Provides customer service relating to all billing inquiries and complaints.  Able to explain insurance processes, benefits, and exclusions.  Follows HIPAA guidelines in handling customer information. 

• Performs other billing duties as requested by the Billing Supervisor, Billing Manager, or Director of Billing.

• Six months to one year of related experience and/or training; or equivalent combination of education and experience.

• Proficient in use of computers and software including, but not limited to:  practice management software, word processing and spreadsheet applications. 

• Detail oriented with ability to multi-task.

• Manages one’s own time with minimal supervision.

• Strong mathematics and problem-solving skills. 

• Seeks and shares pertinent information related to insurance or internal processes. 

• Communicates effectively both verbally and in writing to convey and receive information.

• Use logic and reasoning to identify the strengths and weaknesses of alternative solutions, conclusions or approaches to problems.

• Self-evaluates performance to make improvements or take corrective action. Consider the relative costs and benefits of potential actions to choose the most appropriate one.

• Use equipment, facilities, and materials appropriately as needed to do certain work.

• This position must commit to 9 months in the role before applying for alternative roles within the organization. Exceptions must be approved by Department leadership.