Primary Responsibilities
- Follow-up on claims status and unpaid encounters using payer portals, contacting insurance plans at specific intervals to ensure claims are paid timely and accurately.
- Submitted corrected claims, reconsiderations and appeals via payer portals or paper as required
- Respond to insurance correspondence received by various methods such as fax, mail, email
- Contact clinics, coding and other resources to assist with denials related to medical necessity, eligibility, authorizations and diagnosis
- Submitted appeals for payments according to payer requirements
- Contact patients as appropriate to obtain information needed to update insurance information or provide information regarding coverage issues and coordination of benefits.
- Review encounters for payment demand letters and process bad debt files as appropriate.
- Complete address updates from electronic update files
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications
- High school education OR GED
- Must be 18 years of age OR older
- 1+ year of medical billing experience including: Claims Status, claim appeals/reconsiderations, charge entry, payment entry or AR follow-up.
- Experience with and understanding of ICD10 and CPT coding – including modifiers.
- Experience with computers including Windows based programs including Microsoft Outlook, Word, and Excel
- Working experience as Accounts Receivable Clerk, Medical Biller, Insurance Follow-Up Representative Accounts Receivable Manager, or accountant.
- Solid understanding of collections processes, reimbursement methodologies, state and federal guidelines for compliant billing practices
- Data entry skills
- High degree of accuracy and attention to detail
- Ability to work fulltime, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 4:30pm PST. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications
- Epic Experience
- Oncology/Urology or Allergy billing experience
- Medicare and/or Medicaid billing experience
- Understanding of requirements for billing procedures, drugs, drug waste and office based labs.
- Familiarity with medical terminology
- Ability to calculate expected reimbursement, co-pays and deductibles
- Experience in using electronic claims editing systems and clearinghouse
Telecommuting Requirements
- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft Skills
- Ability to recognize and understand 1500 form data elements, EOB reason codes, remarks codes and claims edits as well as NCDs and LCDs
- Verbal and written communications skills to communicate with providers, payers and others in a clear and professional manner
$16.88 – $33.22/hr
