Perform follow-up activities on outstanding insurance medical claims for Medicare, Medicaid, Commercial and Specialty insurance/program payors. Analyze, screen, and correct claim issues. Process appeals, write-offs, and determine if patient billing is necessary.

• Some knowledge of patient billing or collection/reimbursement procedures in a healthcare setting preferred. Experience in medical claims follow-up functions specific to processing insurance claim appeals for various payors.
• Detail oriented with the ability to organize, prioritize and coordinate work within schedule constraints and handle emergent requirements in a timely manner.
• Ability to multi-task in a fast paced, high-volume environment.
• Proficient in Microsoft Office.
• EPIC experience.
• Experian, TriZetto/Claim Logic.

Education

• High school graduate or equivalent

• Initiates insurance follow up on unresolved appealed or unpaid claims, to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors.
• Submits appeals and reconsiderations on claim denials via practice management system, payor portals, or mail.
• Analyze daily claim rejections from our clearing house, screen claims for pre-authorization, request and submit medical records.
• Work closely with the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claim issues.
• Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility or additional requests from payors
• Assist customer service team in resolving patient billing concerns or disputes.
• Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management team, and clinical departments.
• Completes all other duties as assigned.