The Senior Billing Collections Representative – Acclaim is responsible for billing, collections and reconciliation of all insurance claims. The position processes claims daily, reviews claims for accuracy, performs required edits and submits claim to payers.
Duties and Essential Job Functions:
1. Monitors recurring rejected claims to management for evaluation of impact on the timely filing of claims.
2. Researches and processes credit balances by refund and or adjustment reports and process claims and/or remittance advice/EOB for insurance carriers.
3. Reviews claims for accuracy, performs required edits, submits claims and/or rebills to payors daily to ensure timelines of claim submission.
4. Reviews the rejection reports to determine information needed to complete the billing or claim submission process.
5. Processes claims and or Remittance Advice/EOB for insurance carriers while comparing reimbursement to available contracts.
6. Reconciles Medicare and/or Medicaid remittance advice to patient accounts.
7. Researches and responds to incoming patient, payer, physicians and or representative inquiry by telephone and/or mail within 2 business days of requests.
8. Tracks productivity and provide weekly status reports to the Coordinator, Supervisor and /or Director.
9. Documents all actions taken on accounts in the system account notes to ensure all prior actions are not noted and understandable by others.
10. Reviews claims in SSI, THIN and TexMedNet for missing elements; notifies Medical Records and/or Medical Denial and Appeals of impending filing deadlines.
11. Reports all recurring rejected claims to management for evaluation of impact on the Accounts Receivables.
12. Researches and processes credit balances by refund and/or adjustment reports.
13. Performs other related duties as assigned.
Required Education and Experience:
- High School Diploma, GED or equivalent.
- 1 plus year of Medical Billing/Collector experience.
Preferred Education and Experience:
Required Licensure/Certification/Specialized Training:
Preferred Licensure/Certification/Specialized Training:
- AAHAM Membership.
Knowledge, Skills & Abilities:
- Knowledge of person computers and other standard office equipment.
- Knowledge of Medicare and Medicaid Regulations.
- Skill in time management to ensure accurate and timely completion of assigned tasks.
- Skill in both verbal and written communications in English and Spanish.
- Ability to be detailed oriented and demonstrate basic mathematical skills.
- Ability to analyzing and recognize financial issues as they relate to multiple groups including third party Payors, physicians, patients and the System.
- Ability to demonstrate a positive demeanor, and professional in both appearance and approach.
- Ability to handle potentially stressful situations and multiple tasks simultaneously.
- Ability to solve problems within the guidelines of established policies and procedures.
Job Type: Full-time
- Dental insurance
- Employee assistance program
- Employee discount
- Health insurance
- Life insurance
- Paid time off
- Retirement plan
- Tuition reimbursement
- Vision insurance
- Monday to Friday
- One location
- Temporarily due to COVID-19
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