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Essential Functions and Tasks
- Follows up on claim rejections and denials to ensure appropriate reimbursement for our clients.
- Process assigned AR work lists provided by the manager in a timely manner.
- Write appeals using established guidelines to resolve claim denials with a goal of one contact resolution.
- Identified and resolved denied, non-paid, and/or non-adjudicated claims and billing issues due to coverage issues, medical record requests, and authorizations.
- Recommend accounts to be written off on Adjustment Request.
- Reports address and/or filing rule changes to the manager.
- Check the system for missing payments.
- Properly notates patient accounts.
- Review each piece of correspondence to determine specific problems.
- Research patient accounts.
- Reviews accounts and determines appropriate follow-up actions (adjustments, letters, phone insurance, etc.).
- Processes and follows up on appeals. Files appeals on claim denials.
- Inbound/outbound calls may be required for follow-up on accounts.
- Respond to insurance company claim inquiries.
- Communicates with insurance companies about the status of outstanding claims.
- Meet established production and quality standards as set by Ventra Health.
- Performs special projects and other duties as assigned.
- High School Diploma or GED.
- At least one (1) year in the data entry field and one (1) year in medical billing and claims resolution preferred.
- AAHAM and/or HFMA certification preferred.
- Experience with offshore engagement and collaboration desired.
- Intermediate level knowledge of medical billing rules, such as coordination of benefits, modifiers, Medicare, and Medicaid, and understanding of EOBs.
- Become proficient in the use of billing software within 4 weeks and maintain proficiency.
- Ability to read, understand and apply state/federal laws, regulations, and policies.
- Ability to communicate with diverse personalities in a tactful, mature, and professional manner.
- Ability to remain flexible and work within a collaborative and fast-paced environment.
- Basic use of a computer, telephone, internet, copier, fax, and scanner.
- Basic touch 10 key skills.
- Basic Math skills.
- Understand and comply with company policies and procedures.
- Strong oral, written, and interpersonal communication skills.
- Strong time management and organizational skills.
- Strong knowledge of Outlook, Word, Excel (pivot tables), and database software skills.
