ProScan Imaging is seeking a full-time, Claims Resolution Specialist at our Midtown location.
General Description: Primary task include, but not limited to: consistentlyfollow up on unpaid claims utilizing monthly aging reports, filing appeals when appropriate to obtain maximum reimbursement and establish and maintain strong relationships with providers, clients, patients and fellow staff.
Duties and Responsibilities:
- Coordinates workflow related to resolving outstanding medical accounts receivable, rejected/pending claims, daily correspondence, and interpreting EOB denials
- Make necessary arrangements for medical records requests, completion of additional information requests, etc. as requested by insurance companies
- Daily interactions with insurance carriers via web portals, telephone, scan/fax including Appeal writing and sending supporting Medical Report with physician order to resolve file rejections, and denials.
- Respond to inquiries from insurance companies, patients and providers.
- Maintains A/R averages and goals within the key performance indicators set for the Billing – Claims Resolution Rep.: days in accounts receivable, percentage of net collection, percentage of non-contractual write offs, percentage of A/R over 120, the overall insurance collections for all ProScan sites assigned.
- Utilize monthly aging accounts receivable reports to follow up on unpaid claims aged over 30 days.
- Acts as a resource to Supervisors, ProScan clients, Sr. Manager, COO and other staff to accurately respond to questions/issues pertaining to billing/coding (CPT-4, HCPCS, LCD/LMRP and ICD-9/10).
- Ensures that all work is completed within established timeframes and in accordance with all applicable local, state and federal guidelines.
- Work Task Manager queues according to documented procedures
- Identify and escalate priority issues to the appropriate manager(s)
- Responsible for notifying by email either Sr. Billing Manager, Claims Resolution lead of any new and/or handling process required different than what’s documented in your Billing Manual.
- Perform other reasonably related task as assigned by Manager
- High School diploma or equivalent
- Physician/Clinical billing certificate desired or equivalent 2 or more years of billing/follow up experience
- Physician/Clinical billing desired or equivalent 2 or more years of billing/follow up and/or Insurance claims specialist experience; working knowledge of medical terminology helpful.
- Experience with GE Centricity Practice Solutions practice management system.
- Experience with electronic and paper billing & collections of insurance claims.
- Experience in Radiology billing a plus.
- Experience with payer Web portals a plus
- Experience with CPT-4, HCPCS, LCD/LMRP and ICD-9/10 billing/coding.
- Excellent Computer (PC) Skills; preferred with Centricity (GE).
Knowledge, Skills, and Abilities:
- Current knowledge of HIPAA privacy regulations.
- Excellent oral and written communication skills
- Ability to work independently on assigned tasks
- Excellent attention to detail
- Ability to handle confidential and sensitive information
- Knowledge of HIPAA rules and regulations
Job Type: Full-time
- 401(k) matching
- Dental insurance
- Disability insurance
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Life insurance
- Paid time off
- Retirement plan
- Vision insurance
- 8 hour shift
- Monday to Friday
- High school or equivalent (Preferred)
- Microsoft Office: 1 year (Preferred)
- Customer Service: 1 year (Preferred)
- Electronic/Paper Billing: 1 year (Preferred)
- Collection of insurance claims: 1 year (Preferred)
- Medical terminology: 1 year (Preferred)
- One location
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