Accountable for processing inbound demands from different departments to costs handbook and electronic claims to make sure prompt and total collection of all dollars designated. Validating clients’ insurance protection. Responding to billing concerns from internal and external clients.
Responsible for the prompt billing, correction of edits, follow up of unsettled balances, and appealing of rejections of expert charges for utilized and contracted SGMC service providers. Validating client’s insurance protection and advantages. Addressing billing concerns from internal and external sources.
Responsible for subset of payers and/or alpha split of payer groupings. Will be liable for the total health of the receivables appointed.
Responsible for everyday evaluation of correspondence, exceptional insurance coverage credit balances, over-posted account balances, and paid claims with exceptional balances.
KNOWLEDGE, SKILLS & ABILITIES
Prior expert billing experience advised.
Compiles accessories, remedies claim edits, updates and expenses daily all claims gotten from the electronic system.
Submits claims in Epic PB Resolute Billing system.
Documents and updates status of unsettled insurance coverage balances.
Researches and examines numerous billing referral handbooks to examine billing precision.
Documents electronic system concerning returned faxes and Certified Return Receipts. Finishes production logs. Procedures outbound mail.
Verifies Medicare, Medicaid, and other 3rd Party eligibility utilizing different systems.
Technical/system skills/knowledge: PC and Windows literacy needed; choose understanding of, or experience with, practice EHR systems, Medicare, Medicaid, and other payer web websites, Encoder Pro, Microsoft Office applications, and Experian declare source clearinghouse website.
Extensive understanding of insurance/managed care, to consist of: Medicare; Medicaid (Georgia and Florida); Peach State; Wellcare; CareSource, Amerigroup; Tricare (Standard, Extra and Prime); VA; Disability Adjudication Services; Vocational Rehabilitation; Children’s Medical Services; Cancer State Aid; Crime Victim’s Compensation Program; Knight’s Templar Eye Foundation; Managed Care (HMO, PPO, POS, Medicare HMO); COBRA; Worker’s Compensation; Blue Cross (Georgia, Florida, out-of-state and FEP); and Institutional Billing.
Working understanding of CPT-4, HCPCS, and ICD-10
Knowledgeable of insurance coverage and repayment procedure.
Must have a comprehensive understanding and understanding of: client type; monetary class; insurance coverage master; location of service codes; doctor coding;; relationship codes; lodging, event, worth and condition codes.
Related regulative and legal requirements: Medicare Secondary Payer Questions; medical requirement; Medical Reviews and Appeals.
Interacts with: clients; other departments; doctor workplaces; intense treatment service providers; insurance provider; companies; intermediaries; usage evaluation business; state regulative firms (GMCF, Medicaid); and lawyers.
Knowledge of medical terms. Strong verbal/written interaction abilities, extremely arranged with the capability to focus on work.
Able to interact successfully with a vast array of people. Substantive interaction needed with doctors, insurer, consumers and personnel. Need to be extremely arranged and self-motivated, needing little or no guidance to perform tasks. Capability to focus on and perform numerous jobs to achieve prompt and reliable resolution of client accounts.
Working understanding of medical terms, income, CPT and ICD-10 codes, and 1500 kinds.
Ability to examine and entirely comprehend an EOB, acknowledge issues, and interact payer rejection patterns to manager which forbid payment from insurance coverage providers.
Ability to preserve appropriate levels of performance with very little mistakes. Requirement is 60 accounts minimum daily when training is finished.
Strong analytical, social and interaction abilities needed.
Excellent PC and information entry abilities vital.
Familiarity with HIPAA personal privacy requirements for client details.
Excellent customer care abilities.
CPAR accreditation extremely preferable.
South Georgia Medical.
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