Job Description:Job Summary: The incumbent of this position is responsible for collecting, posting, and managing account payments as well as submitting claims and following up with insurance companies.
Essential Job Functions:- Creates insurance claims for all private insurance billing and submits claims in a timely manner following billing schedule.
- Complete audits of all claims documentation to verify accuracy of charges related to appropriate diagnosis and codes prior to filing claims.
- Maintain an accurate, up-to-date reporting system providing information on insurance billings, processing timelines, verification, pre-certifications, reasons for denial and payment of filed claims on a daily basis.
- Monitor pay habits of contracted insurance companies as well as out-of-network reimbursements and reports this to Leadership quarterly in order to assist in determining the need for additional or re-negotiated contracting.
- Provides follow up on any unpaid or denied claims; submits appeals within industry time frames for denials.
- Communicates status of appeals to program site.
- Deliver appropriate, timely reports to Supervisors and to the Executive Team members as needed regarding accounts receivables, claim status, etc.
- Assist with monitoring of receivable accounts for recommendations of collection, write-off, reimbursements, etc.
- Assist with the development of any new in-house computerized billing systems and client demographics databases.
- Other duties as assigned by the Director, Vice President, and/or Executive Team members.
Knowledge, Skills, and Abilities:- Considerable knowledge in medical billing and collection practices.
- Basic knowledge of medical coding and third-party operating procedures and practices.
- Superior communication and customer service skills
- Excellent 10 key and alphanumeric data entry skills with attention to detail
- Proficient in common word processing, spreadsheet, database, and web-based applications.
Experience and Education Qualifications:- High School diploma with courses in typing and business practices; AND
- At least three (3) years experience in bookkeeping position; AND
- At least two (2) years includes experience in an insurance billing position.
Supervisory Requirements:Employment Requirements:- Successful completion of background check including criminal record, driving record, abuse/neglect and fingerprint check.
- Completion of New Hire Orientation at the beginning of employment.
- All training requirements including Relias at the beginning of employment and annually thereafter.
- Current driver's license, acceptable driving record and current auto insurance.
Physical Requirements:ADA Consideration - Sedentary work: Exerting up to 10 pounds of force occasionally (exists up the 1/3 of the time) and/or a negligible amount of force frequently (exists 1/3 to 2/3 of the time) to lift, carry, push, or pull, or otherwise move objects, including the human body. Repetitive movements of hands, fingers, and arms for typing and/or writing during work shift.Sedentary work involves sitting most of the time but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally, and all other sedentary criteria are met.We are an Equal Opportunity and Affirmative Action Employer, and encourage applications from all qualified individuals without regard to race, color, religion, sex, gender identity, gender expression, sexual orientation, national origin, age, marital status, disability or veteran status, or to other non-work related factors.Preferred Family Healthcare is a Smoke and Tobacco Free Workplace.