Job Abstract

Job Summary

Review the Account Trial Balance report for aging accounts, contact the various payors for payment updates notations and discrepancies, ordering re-bills, transfer financial class, allowance accounts and assisting with submitting claims electronically for expected reimbursement.

Essential Functions

• Follow up on all Government claims within 30 days and Government claims within 15 days for status update on reimbursement.
• Review all accounts assigned to the Work Queue and perform the billing task as identified to ensure timely corrections, submission and reimbursement.
• Responsible for Medicaid HMO payers Account Trial Balance Report
• Confirm prior authorization, pre-certifications and referrals are submitted with the claims for reimbursement.
• Review the ATB weekly for claims that are over 30 days without a payment and investigate reason with through documentation in Series of the findings.
• Post claim adjustments, Re-bill all claims with late charges, incorrect payments, allowances and select appropriate financial class based on the Explanation of Benefits
• Following up on Medicaid HMO Payers via phone Contact or Company Website to avoid untimely filing.
• Check payment status of claims on Insurance Company web site.
• Update Insurance & Demographic information in hospital system stemming from conversations with Insurance Companies, response from Patients receiving statements and return mail
• Responsible for working any Denial on Medicaid HMO Payers.

Other Duties

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Minimum Education/Certifications
High School Diploma Required.

Knowledge of Basic Healthcare and Billing Terminology.

Knowledge of billing standards for Government and Non-Government Insurance plans.

Good communication and customer service skills are a must.

Minimum Work Experience
Prior experience working in a Hospital Billing Department or Collection Agency preferred

Working Conditions

Typical office setting requires sitting, writing and the ability to use office equipment such as computers, calculators, telephone, fax machine and copier. Limited lifting is required. Requires attention to detail and full concentration to assure accuracy.