Role Description Responsible for ensuring claims are compliant with all payer specifications; State, Federal and HIPAA regulations and following up on A/R. Accurately posts electronic and hard copy insurance and patient payments to the patient’s account. This is a full-time, remote position REPORTS TO: Revenue Cycle Manager Duties and Responsibilities: - Analyze assignment of all CPT-4, ICD-9, UB04, HCFA 1500 and charges for accuracy and to maximize reimbursement from third party payers. - Analyze insurance payer denials for appropriate response to ensure claim reimbursement and possible appeals. - Critically analyze and process documents for resolution of third-party liabilities, outstanding credits, and un-billed accounts to resolve accounts receivable. - Ensure that all appropriate financial adjustments are posted accurately and in accordance with contracted payment rates, third party billing requirements. - Stay current with knowledge of payer and regulatory changes. - Ensure that billing is submitted accurately, timely, and within the necessary metrics associated with the role. - Evaluate and investigate appropriate actions to be taken to resolve outstanding receivables, in accordance with department goals. - Utilize various resources such as third-party publications, procedure manuals and participating contractual agreements, etc. - Evaluate and validate correct payments received from third party payers. - Make all necessary posting, adjustments and refunds to accounts and critique contractual allowances and other arrangements. - Research claim payment and claim follow-up, resolving third party rejections using the payer and billing system Insight. - Resolve and collect hospital claims with commercial and government insurance carriers. - Submit billing data to insurance providers through insurance portals and submit third party claim forms (i.e., UB04 or 1500) through the claims editing software. - Understand the claim editing process and resolving the edits based on appropriate department procedures regarding claim submission. - Track and resolve discrepancies, based on partial payment and contracts. - Liaison with UR/Insurance Verification to resolve insurance benefit issues and authorizations. - Work independently and collaborate in a team environment. - Call insurance payers to status outstanding accounts and obtain timely resolution. - Mail patient statements. - Work with Patients to set up payment plans if necessary. - Work with Collection agency to provide any back up information for accounts that are in legal status with the collection agency. - Accurate posting of insurance payments, contractual, denial codes and patient liability ensuring the account balance is appropriate. - Balance batches to posting, researching, and resolving any variances. - Researching and resolving unidentified payments within 10 days of the receipt date. - Maintains a professional image and provides excellent customer service. - Attend department meetings and education sessions. - Meets/exceeds performance expectations within required timeframes. - Supports special projects as requested. - Adheres to all Policies and Procedures. - Performs other duties as assigned. Qualifications - High school Diploma or equivalent required. - CPC, CCS or RHIT Certification preferred. - Minimum of one to three years’ experience in handling billing, account receivables and cash posting in healthcare or related field. - Strong working knowledge of medical coding, medical terminology and third-party operating procedures and billing practices. - Working knowledge of EMR/Billing systems. Requirements - Ability to multitask and work independently and under pressure. - Understanding of community-based organizations/CMH. - Knowledge of CPT and ICD9 codes. - Strong verbal and written communication skills. - Ability to operate a computer, including Billing based programs, and general office equipment, including fax machine, scanner, and copier. - Ability to work proficiently and efficiently in a timely manner. Physical Effort The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. - Requires prolonged sitting and some bending, stooping, and stretching. - Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. - Requires normal range of hearing and eyesight to record, prepare, and communicate appropriate reports. - Requires lifting papers or boxes up to 50 pounds occasionally. - Work is performed in an office environment and involves frequent contact with staff and the public. Work Environment - Requires critical thinking skills, problem solving, decisive judgment, ability to work with minimal supervision and must possess excellent time management and organizational skills. - Must be able to work in a stressful environment and take appropriate action.