Under general supervision, responsible for performing any combination of routine calculating, posting and verifying duties to obtain primary insurance data for use in preparing statements to patients' insurance carriers. May prepare notices to patients of amount expected (or received) from insurance and amount expected from patient.
- Initiates insurance follow up on unresolved appealed or unpaid claims, to ensure maximum and timely reimbursement for Medicare, Medicaid, Commercial, or Specialty insurance/program payors.
- Submits appeals and reconsiderations on claim denials via practice management system, payor portals, or mail.
- Analyze daily claim rejections from our clearing house, screen claims for pre-authorization, request and submit medical records.
- Work closely with the Coding, Payment Posting, Managed Care Operations, Provider Enrollment, and Clinical Operations to resolve claim issues.
- Review and respond to insurance correspondence letters related to recoupments, refunds, eligibility or additional requests from payors
- Assist customer service team in resolving patient billing concerns or disputes.
- Verify patient benefits and insurance eligibility, perform claims status verification, navigate through insurance websites for specific payor guidelines, and effectively communicate findings to insurance companies, management team, and clinical departments.
- Completes all other duties as assigned.
- High School Graduate or Equivalent is required.
