ESSENTIAL FUNCTIONS:

Responsible for verification and interpretation of insurance benefits and establishing financial arrangements with guarantor/patient.  Estimate patient out-of-pocket and make financial arrangements with guarantor/patient.  Post payment and follow up with claims.  Prepare and review all billing forms to ensure accuracy and completeness for claims submission to insurance carriers and back up for Medicare and Medicaid claims. Process claims electronically or hard copy with 100% accuracy and mail claims timely. Enter documentation and adjustments through computer system to maintain a correct account balance. Update system information according to correspondence received and processed.  Document any changes and submit to appropriate staff. Review charge summaries on each patient bill that is produced and identify discrepancies with 100% accuracy. Consistently apply appropriate procedures to prevent accounts from becoming delinquent or remaining unbilled. Initiate appropriate follow-up and collection calls. Review remittance advice statements for payments and adjustments on a daily basis and initiate appropriate data entry for patient charge or account discrepancy on review. Identify denial and pending reasons and investigate, resolve and initiate information to secure reimbursement.

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

High school diploma or equivalent required.  Must have at least 3 years' experience in related field.  Must have extensive knowledge and understanding of Commercial Insurance and Medicare/Medicaid.