Medical Billing Coordinator
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Job Description
Medical Billing Coordinator handling claims management and reimbursement processes for healthcare clients. Collaborating with insurance carriers and maintaining documentation of claims procedures while working in a remote setting.
Responsibilities:
- Ensures timely and accurate reimbursement by managing outstanding claims and collaborating with insurance carriers, providers, and billing teams
- Conducts timely and accurate follow-up on professional services claims to ensure all requested information has been submitted and claims are being processed utilizing payor portals, secure chat, secure messaging, and telephone calls
- Identifies missing payments from the health plan and initiates tracking procedures
- Reviews incoming correspondence from health plans and takes appropriate action or escalates to designated team members as needed
- Identifies pending claims and determines next steps required to obtain reimbursement for claim
- Uses existing queries to review limited new denials for processing errors, appropriately assigns a status based on review, corrects any internal errors and resubmits claims as necessary
- Follows up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution
- Monitors incoming messages from providers and responds to the provider or escalates the request to the appropriate team member
- Identifies claims with more complex issues and escalates them to the appropriate team member for resolution as needed
- Research health plan reimbursement policies and procedures, clinical guidelines, coding, and CCI edits to ensure claims are billed appropriately
- Communicate effectively with insurance companies, healthcare providers, and their billing staff to resolve claims issues and answer inquiries
- Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures
- Prepare and submit reports on claim follow-up activities and status updates to management as requested
- Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements
- Stay updated on changes in insurance policies, regulations, and industry standards
- Must meet quantitative production standard of working 100 – 150 claims per week
- Attend departmental and company meetings as required
- Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues
- Investigate and resolve discrepancies or issues related to claims processing and payment
- Work with other team members and departments ensure proper claim submission
- Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process
- Participate in training and development opportunities to stay current with best practices and industry trends.
Requirements:
- A minimum of 3 years’ experience as a medical biller or similar role
- Excellent technical skills including the ability to work in multiple systems simultaneously and learn new systems quickly
- EZ-Cap experience preferred
- Electronic Data Interchange (EDI) Clearinghouse (Office Ally) experience preferred
- Microsoft Suite – Outlook, Teams, Office365, OneNote, OneDrive, SharePoint
- Sequel Server Management Studio
- Confluence
- Azure
- Thorough knowledge of healthcare benefits, network participation, coordination of benefits, referral and authorization requirements, and insurance follow up
- Working knowledge of CPT Codes, ICD-10 Codes, Modifiers, MUE, LCD, NCD, and CCI edits
- Must have strong time management skills, be able to multi-task, resolve problems utilizing critical thinking, be detail oriented and highly organized
- Ability to work in a fast-paced environment while maintaining strict confidentiality
- Excellent written and verbal communication skills.
Benefits:
- 100% employer paid medical, vision, dental, and life coverage
- Paid holiday, sick time, and vacation time
- 401k plan
- Additional employee paid coverage options available
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