Job Detail Page

Responsibilities:

• Make outbound calls to insurance companies to inquire about the status of claims.

• Identify and resolve claim denials, exceptions, or exclusions.

• Read and interpret insurance Explanation of Benefits (EOBs).

• Maintain accurate and detailed notes regarding collection efforts.

• Follow up on unpaid claims within standard billing cycle timeframes.

• Investigate and appeal denied claims.

• Handle patient inquiries on account status and charges.

• Maintain strict confidentiality in accordance with HIPAA regulations and company policy.

• Work with the billing team to ensure all bills have been dispatched to the relevant parties.

• Stay informed about changes in insurance policies, procedures, and regulations.

Qualifications:

• Previous experience in AR calling is preferred, but not mandatory.

• Strong knowledge of medical insurance (HMO, PPO, Medicare, Medicaid, etc.).

• Understanding of medical terminology, ICD-10, CPT, and HCPCS coding.

• Proficient in MS Office and data entry, experience with medical software preferred.

• Excellent communication, negotiation, and problem-solving skills.

• Attention to detail and ability to analyze insurance EOBs

• Willingness to stay up-to-date with healthcare laws and regulations.

• Respect for patient confidentiality and adherence to HIPAA guidelines.

• Ability to work independently and manage time efficiently.

Responsibilities:

• Analyze and resolve issues related to unpaid medical claims and denied claims.

• Follow up with insurance companies to inquire about claim status and resolve issues.

• Interpret Explanation of Benefits (EOBs) to ensure correct payment, adjustments, and patient responsibility.

• Communicate with providers and patients regarding billing issues, as needed.

• Document all activities related to accounts receivable follow-up in a consistent and comprehensive manner.

• Meet key performance indicators as established by management, such as reducing the number of denied and rejected claims.

• Review and appeal unpaid and denied claims.

• Maintain patient confidentiality and adhere to HIPAA regulations.

• Stay up-to-date with changes in medical coding and billing practices, insurance policies, and healthcare regulations.

• Understanding of medical terminology, CPT, ICD-10, and HCPCS coding.

• Proficiency in using medical software systems and Microsoft Office Suite.

• Excellent written and verbal communication skills.

• Detail-oriented with strong analytical and problem-solving abilities.

• Understanding of insurance guidelines, including Medicare and state Medicaid.

• Ability to maintain patient confidentiality and adhere to HIPAA guidelines.

• Ability to work independently and collaboratively within a team environment.

• Able to prioritize and manage multiple tasks simultaneously.

• Strong customer service skills for interacting with patients regarding medical claims and payments.

• Willingness to stay up-to-date with changes in healthcare laws and regulations.