Business Office Specialist (Denial Appealer) - FT- Days
This position is responsible for business office activities which include patient billing, customer service, and transmission of all electronic claims several times a day, with the set up and monitoring of new insurance plans.
- High School Diploma/GED is required
- Comprehensive knowledge of healthcare billing.
- Understands medical terminology.
- Excellent Customer Service
- Familiarity with EOB’s and RA’s.
- Must be able to multi-task, and work with frequent interruptions
- Good written and verbal communication skills are required
- Ability to read, write and speak English
- Ability to communicate clearly and concisely with all levels of management
- MD billing office experience required, hospital experience preferred.
- Communicates clearly and concisely; and is able to work effectively with other employees, patients and external parties
- Demonstrates proficiency in Microsoft Office applications, be able to type at least 35 WPM, and good working knowledge of Excel is required.
- Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly and spell correctly.
- Medical Terminology, ICD-9 Codes, CPT Codes, HCPCS code, Modifier knowledge is preferred.
- Requires reasoning ability, good independent judgment and working with frequent interruptions.
- Ability to use the internet to obtain information from Third Party Payers or other sources is required
- Promotes the facility mission, vision and values by effectively communicating them to others. Considers mission, vision and values in developing services, standards and practices
- Perform daily billing, including abstracts, interim bills, late charges, re-bills and split bills
- Transmits all claims worked by billers to all insurance carriers three times a day
- Submits professional 1500 claims as needed
- Works claims that have been placed on hold to ensure bills are released timely.
- Assist patients with questions and concerns regarding the billing of their accounts.
- Downloads and posts the electronic remit acknowledgement reports.
- Works the exclusion and rejection reports from Claims Administrator and makes any needed corrections, re-bill claims and balances daily billing
- Serves as a resource for billers, collectors, customer service, appeals staff and other departments.
- Monitors billing not imported report
- Monitors MD’s with no NPI numbers and locates them in order to update system for billing compliance
- Monitors Rehab, Oncology billing report and outstanding billing report
- Monitors billing edits and releases and makes updates as needed.
- Responds to all mail, email and phone calls in a timely manner.
- Completes provider applications for payers to set up for electronic billing and payments.
- Create I-Plans in Paragon and Claims Administrator as needed.
- Opens tickets with McKesson for issues with Claims administrator and follow up to resolution
- Ensures patient confidentiality requirements are met in accordance with HIPAA/PHI policies and procedures.
- Other duties and special projects as needed.
LINES OF REPSONSIBILITES:
CFO …. Director …. Manager ….. Supervisor