Core Competencies

• Posts hospital and office charges and payments.
  
  
• Reviews explanation of benefits to resolve accounts.
  
  
• Reviews claim scrubber and resolves claim edits.
  
  
• Identifies and resolves payer issues and patient billing complaints
  
  
• Maintains payor-related items, such as EFTs and Payor IDs for 835s.
  
  
• Manages staff to oversee Explanation of Benefits are returned to staff within 1 week of request.
  
  
• Verifies insurance eligibility and authorization.
  
  
• Transmits electronic/ remittances and statements.
  
  
• Works monthly aging of PPO's, Medicare, HMO's, cash and Workers Compensation.
  
  
• Runs aging and month end reports.
  
  
• Documents detailed notes including action items taken, when appropriate.
  
  
• Responds timely and accurately to all incoming correspondence and inquiries from payers, patients and other departments.
  
  
• Performs collection actions including contacting patient, insurance companies, or third party payers.
  
  
• Reviews reports to identify denials from Medicare, PPOs, Worker Compensation, Commercial and Contracted carriers; corrects and resubmits claims using accurate ICD-9,ICD-10 and CPT codes; suggests action plans to eliminate denials in the future.
  
  
• Prepares and submits write off requests to Supervisor for denied claims that cannot be appealed.
  
  
• Elevates issues as appropriate to Supervisor.
  
  
  
• Participates in Performance Improvement.
  
  
• Assists with orientation and training of new employees/ volunteers, as assigned.
  
  
• Understands basic computer programs.
  
  

Department Specific Competencies

Education

Experience

License / Certification Requirements

Compensation Range: 

$25.00 - 33.44 / Hour