The accounts receivable claims specialist position reviews all outstanding revenue for Valley Sleep Services, Physicians, DME and Patient Invoices; pursues collection of all claims until payment determination is made and performs other work associated with the billing process.
- Initiate claim follow up with insurance companies in regards to disputes to resolve denials and pending claims.
- Research and resubmit claims through paper and/or EDI transmission. Ensure timely resolution of claims payment.
- Investigate and resolve billing discrepancies resulting in overpaid/underpaid accounts.
- Ensure revenue is maximized based on submitting claims for coordination of benefits to appropriate secondary and tertiary payers.
- Provide quality control of insurance claims to ensure proper billing information is submitted including patient demographics, insurance, ICD, CPT and HCPCS codes. Monitor claims for missing information and authorizations.
- Utilize analytical skills to review outstanding billing and revenue in order to report irregularities to management and evaluate opportunities to maximize revenue.
- Submits medical documentation and records as needed and requested to comply with HIPPA and Practice requirements.
- Enter all calls and all notes for documentation. Includes all insurance company and patient and all internal and external correspondence.
- Identifies patterns of insurance and patient concern.
- Ensure appropriate credit adjustments, write off allowable amounts and review for write off amounts are compliant with write-off policy and reported to management.
- Responsible for posting of payments and denials received electronically and through the mail.
- Maintains current knowledge of and adhere to payer and regulatory guidelines for medical insurance claims processing and reimbursement.
- Performs other duties as required.
- Minimum of 1 year of billing experience and/or completion of accepted medical billing course
- Knowledge of insurance billing
- Knowledge of ICD coding, CPT, HCPCS codes and regulatory guidelines
- Ability to multi-task
- Attention to detail
- Strong typing and data entry skills
- Strong computer skill, including Microsoft Excel and Word
- Exceptional organizational skills
- Effective communication skills
- Ability to perform repetitive tasks
- Ability to work in a fast paced environment
Job Type: Full-time
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