Medical Claims Follow Up Specialist

Medical Claims Follow Up Specialist 15 views

Job Overview

  • Salary Offer Commensurate with Experience
  • Experience Level All, Some Experience, Mid-Level
  • Total Years Experience 3-5
  • Education 2-year degree

The Physician Billing Specialist is responsible for resolving unpaid or rejected insurance accounts which have not been collected through routine billing. The Physician Billing Specialist will follow up with the payers determining the best collection technique, resulting in payment or resolution of the outstanding claim. This role will efficiently and effectively use EPIC and will adhere to documented policies and procedures related to billing guidelines.

Responsibilities:

With general direction of the Manager and with latitude for initiative and judgment:

  • Maintains and exercises thorough knowledge of third party billing requirements and insurance regulations to review and follow up on unpaid insurance claims bringing about prompt payment of all outstanding receivables.
  • Initiates task completion in EPIC by review of the invoice and determine invoice resolution by phone calls, correction of a claim – rebilling, investigation of medical documentation, addition of a modifier, claims appeal, etc.  Prioritizes account work efficiently and effectively.
  • Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing prior to charge entry. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims.
  • Follows up on ‘non-routine’ denied accounts through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc.  Researches claims, identifies problems and takes appropriate action to assure claim resolution.
  • Mails paper claims with appropriate attachments when needed (insurance EOB, medical records, etc.).  Processes Medicaid claims thru ePaces.  Ensures additional documentation and/or information is provided for claims processed thru iHCFA, Claim Logic, CBAS, ePaces, etc. ensuring claims are billed without error.
  • Prepares reports for management to document recurring problems and identifies the source of reimbursement delays.  Works closely with management to ensure effective communication to resolve invoice payment delays.
  • Completes special projects as assigned.

Qualifications:

Associate’s degree in Business Administration and 2 years of hospital patient accounting or consumer collections experience, or certification obtained from a nationally accredited billing program (i.e., Certified Medical Billing Specialist CMBS, Certified Medical Records Technician CMRT, Certified Medical Reimbursement Specialist CMRS); or an equivalent combination of education and experience.  Ability to type 25 wpm.

Preferred Qualifications

  • Experience working with the EPIC system.
  • Strong knowledge of physician/professional fee billing or consumer collections experience; or an equivalent combination of education and experience.
  • Third party billing guidelines and knowledge. Excellent interpersonal and communication skills. Good organizational skill.
  • Experience working with automated billing systems and knowledge of Microsoft Word, Microsoft Excel.
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