Performs accounts receivable activities to maximize reimbursement from claims. This role works within electronic medical record and billing systems to obtain, produce, and transmit records required by insurance carriers or third parties. The position involves reviewing explanation of benefits, responding to denials and correspondence, following up on open balances, and documenting actions clearly and accurately.
Responsibilities include:
- Comply with governmental, regulatory, company billing/AR, and payer-specific policies
- Analyze explanation of benefits and prepare responses to insurance carriers based on claim adjudication
- Follow up with payers and related parties to collect open balances and ensure compliance with payer guidelines
- Identify and report payer issues such as rejection trends, denial trends, and payment changes
- Address denials and zero payments by providing requested documentation or referring claims for corrections
- Complete follow-up tasks on pending accounts until resolution
- Use office equipment and software to support claim finalization
Requirements & Qualifications
- High school diploma or GED required
- 2+ years of medical collections experience required
- Intermediate proficiency with Microsoft Office Suite (Outlook, Excel, Word, Teams) and PDF software (NitroPro)
- Familiarity with insurance payer rules and regulations
- Strong multitasking, analytical, and problem-solving skills
- Effective verbal and written communication skills, including professional phone skills
- Detail-oriented and able to work independently with minimal supervision
- Ability to maintain confidentiality and work collaboratively with a positive attitude
- Previous experience with multi-state practices preferred
- Previous out-of-network experience preferred
Location
San Antonio, Texas, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
2 months ago