The purpose of this position is to submit inpatient and outpatient claims to Government payors, and to follow-up these claims until payment is received and/or accounts are resolved.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Process claims reports and upload all accounts that requires claim submission
- Verify eligibility, member benefits, authorization requirements and billing address of each claim to be submitted
- Review UB04 information, correct claim errors, print and submit each UB04 claim with all the required attachments
- Track receipt of each claim, and periodically call or check online for claim status
- Work the claims dashboard for claim follow-up and documentation
- For claims paid, verify receipt of payment and review if paid in accordance with expected reimbursement
- File appeal or grievances for denied or underpaid claims
- Request adjustments to resolve paid, underpaid or denied accounts
- Assist in the preparation of claims reports
- Closely communicate and coordinate with the client hospitals with respect to their accounts
- Respond to other tasks assigned by the department manager
QUALIFICATIONS AND REQUIREMENTS
- Completed Medical Billing Course or has equivalent of at least 6 months billing experience
- Read, speak, write and understand the English language fluently
- Keyboarding skills, at least 35 wpm
- Working knowledge of Outlook, Word, and Excel
- Dependable and highly detailed individual
- Willingness to learn new systems and functions
- High commitment to customer service to our internal and external clients
- Possess a high level of integrity – must show good judgment and confidentiality at all times
- Must occasionally lift and/or move up to 20 pounds
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required.
- High School diploma required.
- Good working knowledge of MS Office, Windows and Exchange email required.
- Excellent customer service skills (friendly, courteous and helpful).
- Ability to effectively communicate both in writing and verbally, as well as to interact in a professional manner with colleagues, patients, public, and client’s staff members.
- Strong analytical and problem solving skills a must
- Ability to multi-task; excellent organizational and planning skills required.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is frequently required to sit; use hands to finger, handle, or feel; and reach with hands and arms. The employee is occasionally required to stand and walk and must occasionally lift and/or move up to 75 pounds.
The duties listed above are intended only as illustrations of the various types of work that may be performed. The omission of specific statements of duties does not exclude them from the position if the work is similar, related, or a logical assignment to the position.
This job description is to serve as a guide but no way is it to be considered a comprehensive list of task, duties and responsibilities that will be required by the employee.
To join our team of 2,000 employees and growing, please apply directly to this posting.
MedData is an Equal Opportunity Employer