Medical Biller/Collections Specialist

Insurance Billing and Insurance Collections. Reviewing patient statements and working closely with patients to collect on open balances.

• Review/update demographics and patient information for accuracy.

• Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.

• Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e., identification of payment discrepancies, inappropriate requests)

• Investigate all denied services to determine the reason for the service denial, appeal, if appropriate. Identify and report root causes associated with denials.

• Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)

• Maximize utilization of Billing system, tools, and resources to support cash collection activities.

• Review and work various reports including aging, adjustments, and credit balances.

• Comply with Federal and State legislation pertaining to all billing related matters.