Duties & Responsibilities
• Submit insurance claims manually, via fax, and insurance portals when required.
• Responsible for contacting insurance carriers and following up on outstanding claims.
• Identifying, completing, and resolving insurance denials in a timely manner to expedite claims processing and payment.
• Knowledge of insurance EOB’s layout/ language and requirements for various insurance carriers.
• Appealing insurance claims when required.
• Ensuring excellent customer service is provided when following up on outstanding claims.
• Responsible for daily/ weekly & monthly reporting of following reports: Dept Overview, productivity reports, Posting Review Schedule, Insurance Negotiations/ Settlements.
• Identify insurance trends that negatively impact cash collections, utilize training tools provided to resolve issues and/or escalate to Dept Manager/ Director.
• Responsible for completing Dept projects as assigned.
• Provide General administrative and clerical support including but not limited to, receiving, and sorting daily mail, maintaining medical records, faxing, copying, and scanning.
• Work closely with Dept Managers/ Supervisors to create improvement & implement processes to ensure Dept goals and objectives are met in a consistent
Education and Experience
• High School Diploma, associate degree preferred.
• Ambulance/Medical billing certification or diploma preferred.
• Maintain working knowledge of ICD-10, CPT and HCPCS coding, NPI, HIPAA, Modifiers, EPCR’s and all forms of medical billing (direct, 3rd party, HMO’s, private pay, no-fault, worker’s comp, Medicare & Medicaid
• Excellent organizational skills and the ability to multi-task in a fast-paced environment
• Review and research data; use intuition and experience to complement data.
• Thorough knowledge of transport documentation (PCRs)
• Ability to follow up on outstanding insurance claims.
• Ability able to submit appeals and overpayment requests.
• Health Insurance Portability and Accountability Act (HIPAA) requirements and record retention compliance.
• Excellent written and verbal communications skills required · Excellent documentation skills (promptness, accuracy, thoroughness, and legibility).
• Credit & Collections Procedures, Payment Plan/ Settlements.
• Customer Service/ Client relations.
Competencies
• Working knowledge of EMS systems/private ambulance and medical transportation systems preferred.
• Knowledge of Waystar/ Clearinghouse.
• Knowledge Microsoft Word, Microsoft Excel, and Microsoft Windows.
• Familiarity with medical terminology
• Organizational and leadership abilities, detail oriented.
Work Environment
• Work is performed under normal working conditions, as in a standard office environment.
Physical Requirements
• High level of sitting/working at a desk
• Light physical effort (lift/carry up to 10 lbs.)
• Must be able to perform the essential duties of the position with or without reasonable accommodations