Generates and reviews claims reports for accuracy. Prepares and submits claims to Medicare and insurance companies for payment electronically or via mail in a timely manner.
Reviews and processes Explanation of Benefits (EOB) statements received from Medicare, Medicaid and other insurance providers. Applies adjustments to patient accounts by entering approved amounts into the billing system.
Reconciles and balances accounts.
Responds to calls from customers, insurance providers, customer service personnel, and others regarding billing concerns. Reviews customer accounts and provides necessary follow-up to ensure for customer satisfaction. Prepares account histories for customers as requested.
Reviews insurance denials and researches reason for denial. Performs necessary account follow-up by contacting insurance companies and others to resolve payment discrepancies. Submits corrections or bills the patient or other insurance.
Reviews the aging report and provides necessary follow-up and research to resolve outstanding claims. Contacts customers for payment. Creates and generates collection notices. Files and maintains collection documentation.
Processes all changes in customer insurance coverages (carrier, benefits, coverages). Verifies change in insurance coverage has occurred. Contacts insurance company to verify eligibility, benefits, and requirements. Obtains necessary documents (e.g. prior authorizations, Letter of Medical Necessity, sleep study documentation, O2 saturations, etc.). Ensures appropriate change is made in DME database.
Education & Experience:
High school diploma with some vocational training in Accounting, Business Administration or a related field and one to two years prior billing experience in a health care environment or any other combination of education and experience that provides equivalent knowledge, skills or abilities.
Knowledge of general accounting principles and practices.
Knowledge of Medicare and Medicaid regulations, requirements and reimbursement criteria.
Knowledge and application of ICD-9 and HCPC coding.
Ability to use a computer for e-mail, data inquiry, data entry and word processing. Ability to create and utilize spreadsheets. Ability to run queries and reports from the financial system and Medicare system.
Skilled in Outlook, Word, Excel and computerized billing systems.