About this role
Role Overview
- Review and verify patient demographic and insurance information to ensure accuracy.
- Confirm that all necessary documentation and authorization are in place before submitting claims.
- Review and assess medical claims for accuracy and completeness.
- Identify discrepancies or missing information and rectify them promptly.
- Review and update claim documentation as necessary.
- Submit medical claims to insurance companies following established billing guidelines.
- Utilize billing software and systems to ensure accurate and timely claim submission.
- Monitor and track the status of submitted claims.
- Analyze and address claim rejections promptly.
- Make necessary corrections, resubmit claims, and follow up to resolve outstanding rejections or claim edits.
- Stay up to date with healthcare regulations and insurance policies.
- Ensure billing practices adhere to industry standards and compliance requirements, including HIPAA.
- Ensure insurance coverage and eligibility.
- Review each claim and adjust the incorrect information accordingly.
Requirements
- High School (HSC) or graduate or equivalent with strong analytical skills.
- Proven experience in medical billing and claim rejection management.
- Proficiency in medical billing software and electronic health record (EHR) systems.
- Knowledge of medical terminology, ICD10, CPT, and HCPC coding.
- Detail-oriented with a high level of accuracy.
- Knowledge of healthcare regulations and compliance (HIPAA, CMS guidelines, etc.).
- Problem-solving and critical-thinking abilities.
- Familiarity with insurance processes and payer guidelines.
- Basic working knowledge of computers.
- Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Experity, AdvanceMD.
- Familiar with clearinghouses like Waystar, Realmed Availity, Change Healthcare, via track.
- Proficiency with MS Excel, MS Word, Outlook, etc.
Benefits
- Health insurance
- Professional development opportunities