Summary of Duties: Reviews and resolvesunpaid claims, resubmits claims as necessary, prepares take-backs, works denials and addresses various billing issues with third party payers and patients.

Classification:Full-Time /Hourly / Non-Exempt

Supervision Received: Reports to Billing Manager.

Essential Functions:

  1. Performs a thorough and consistent research of and follows up on accounts with outstanding claims using periodic and regular aging reports.
  2. Contacts the patient and/or third party payer as appropriate.
  3. Prepares appeals via appropriate means according to carrier guidelines for all claims that require reconsideration for appropriate or additional payment.
  4. Identifies and re-assigns financial responsibility as appropriate. Evaluates patient’s financial status and establishes budget payment plans as needed.
  5. Prepares and approves statements for services that become the patient’s responsibility.
  6. Performs various collection actions as necessary.
  7. Documents all activity taken in each patient’s account.
  8. Processes all non-payment correspondence, underpayments, or overpayments.
  9. Participates in educational activities. Attendsregular team meetings and all company-wide meetings.
  10. Maintains knowledge of multiple practice management systems that MedComm uses to manage the revenue cycle process for its clients.
  11. Conducts self in accordance with MedComm’s employee manual.
  12. Maintains strictest confidentiality and adheres to all compliance regulations.
  13. Assists MedComm by supporting all contractual timelines as outlined in the Billing Service Agreement for each assigned client.
  14. Accepts and completes other duties as assigned by Team Lead or Billing Manager.

Education:

Associate or bachelors degree in business or related field is preferred.

Skills/Experience:

  1. Three (3) years previous medical billing experience required.
  2. Knowledge of CPT and ICD coding required.
  3. Charge/payment entry experience required.
  4. Ability to read and understand an EOB required.
  5. Ability to research an account and identify actual and potential causes for payment delays. Understanding of correct steps needed to resolve delays.
  6. Must have excellent oral communication skills.
  7. Must be well organized and detail-oriented.
  8. Experience with Microsoft Outlook, Excel and Word.
  9. Knowledge of business office equipment and common procedures.

Environmental/Working Conditions:  Normal office environment.  Occasional overtime may be required as business needs dictate.

Physical Demands:  Requires sitting and standing associated with a normal office environment.  Manual dexterity needed for using a telephone and computer keyboard.