Overview

Responsible for the management of Medicare/Medicaid or Private Insurance accounts through patient written and verbal directions, aged trial balance reports, and Medicare rejection reports for the accurate and timely filing of claims for maximum reimbursement. Ability to provide support to other Accounts Receivable departments, as needed. Adhere to all departmental policies and procedures.

Responsibilities


  • Customer service duties include answering telephones for patients and others regarding billing inquiries and resolving billing issues.
  • Act as resource to personnel and clients regarding Medicare/Medicaid or Private Insurance compliance guidelines.
  • Accurately enter information provided by various sources to correct claims in regards to CPT and ICD‑10 codes and send out in a timely manner to Medicare/Medicaid or Private Insurance .
  • Audit accounts showing Medicare/Medicaid or Private Insurance denials to resolve balances.
  • Ability to interpret Explanation of Medicare/Medicaid or Private Insurance Benefits.
  • Resolve invoices from outside laboratories for Medicare/Medicaid or Private Insurance patients.
  • Ability to stay work focused and perform job duties efficiently and accurately. Must have strong organizational skills.
  • Strong data entry skills, with the ability to meet production guidelines as set by the Accounts Receivable Director.
  • Employee must comply with Clinical Pathology Labs' compliance policies and procedures.
  • Duties include but are not limited to the above mentioned responsibilities.

Qualifications

Education:  High School Diploma or GED

Experience:  Preferred at least 1 year in a standard Medicare, Medicaid or Private Insurance role

Skills:  Ability to communicate effectively at all levels within the company and with patients and physician office staff. Medicare/Medicaid or Private Insurance Background

  • Claims Exp-reading EOB/CSR
  • Verify ineligibility
  • Medicare, Medicaid or Private Insurance exp
  • Follow up with billing/payment exp a plus (example-claim was denied, errors)
  • Typing/10 key test to be given after interview 40 wpm min
  • Microsoft Office
  • Email etiquette
  • CSR/Phone Customer Care
  • Strong organization and data entry skills
  • Must have ability to meet production guidelines set by A/R Director
  • Individual metrics to meet- Weekly production of 300 accounts/ passing of audits every month

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