ESSENTIALS DUTIES AND RESPONSIBILITIES:
· Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.
· Manage daily work queue to prioritize high dollar claim balances.
· Review & work incoming insurance and patient correspondence including refund requests.
· Send appeals when appropriate or provide the requested medical documentation.
· Ability to review medical documentation to justify medical necessity.
· Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
· Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
· Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
· Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
· Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
Required Skills:
· 2 years of revenue cycle
General knowledge of the healthcare industry insurance/EOB payment process
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