About the position Responsible for working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers. Review and prepare claims for manual and/or electronic billing submission. Reviews insurance rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding rejections. Correct and identify billing errors and resubmit claims to insurance carriers. Update CAS segments on secondary electronic claims as needed. Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans. Verifies receipt of claim with insurance plans, determining the next appropriate action step. Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients. Obtains and attaches referrals to appointments/charges. Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals. Identifies and communicates trends and/or potential issues to the management team. Follows and maintains all HOPCo policies and procedures. Other duties as assigned.

Responsibilities

• Working claim errors in claims management system ensuring clean claims are submitted timely to insurance carriers.
• Review and prepare claims for manual and/or electronic billing submission.
• Reviews insurance rejections to determine the next appropriate action steps and obtain the necessary information to resolve any outstanding rejections.
• Correct and identify billing errors and resubmit claims to insurance carriers.
• Update CAS segments on secondary electronic claims as needed.
• Verifies patient demographic information and insurance eligibility including coordination of benefits; updates and confirms as necessary to allow processing of claims to insurance plans.
• Verifies receipt of claim with insurance plans, determining the next appropriate action step.
• Researches all information needed to complete the billing process including obtaining information from providers, ancillary services staff, and patients.
• Obtains and attaches referrals to appointments/charges.
• Maintains satisfactory productivity rates and ensures the timeliness of claims reimbursement while maintaining work queue goals.
• Identifies and communicates trends and/or potential issues to the management team.
• Follows and maintains all HOPCo policies and procedures.
• Other duties as assigned.

Requirements

• High school diploma/GED or equivalent working knowledge preferred.
• Minimum of two to three years of experience in medical billing.
• Must have strong knowledge of resolution to payor edit reports, and reconciliation of clearinghouse and payor acceptance reports.
• Knowledge of ICD-9, ICD-10, HCPS, and CPT coding, medical terminology, Medicare reimbursement guidelines, billing practices.
• Knowledge of government regulatory requirements and commercial contracts.
• Advanced computer knowledge, including Window based programs.
• Skill in providing excellent customer service.
• Skill in using computer programs and applications.
• Skill in establishing good working relationships with both internal and external customers.
• Ability to multi-task in a fast-paced environment.
• Must be detailed oriented with strong organizational skills.
• Ability to understand patient demographic information and determine insurance eligibility.
• Ability to work independently and demonstrate the ability to analyze data.

Nice-to-haves

• Prior experience working on claim errors in a claims management system preferred.
• Candidates with knowledge of ANSI formatting preferred.