Secures accurate and timely payment for services by performing medical billing, claim submission and follow-up, payment posting, denial resolution, appeals, accounts receivable management, patient account resolution, reconciliation, and reporting for medical, dental, optometry, and/or behavioral health services.
The role also verifies insurance coverage and benefits, coordinates referrals and prior authorizations, supports financial eligibility programs, and works with patients, providers, staff, and payers to reduce denials, determine financial responsibility, and support access to care.
Key responsibilities
- Process assigned charges and claims independently; review documentation, diagnosis and procedure codes, modifiers, charges, and payer requirements.
- Submit accurate claims within timely-filing limits.
- Monitor claim status and resolve rejected, denied, unpaid, or underpaid claims.
- Research payer policies, medical necessity requirements, contracts, fee schedules, and allowable amounts.
- Prepare corrected claims, reconsiderations, and appeals.
- Post patient payments, adjustments, and other account activity.
- Review remittance advice and resolve discrepancies, underpayments, overpayments, credit balances, and refunds.
- Verify coverage and coordination of benefits; correct payer order and rebill claims as needed.
- Generate patient statements, answer billing questions, collect payments, and manage payment arrangements.
- Process and balance credit-card transactions, deposits, daily postings, weekly reconciliation, and month-end closing procedures.
- Maintain account notes, work queues, supporting records, and desktop procedures.
- Prepare and provide Good Faith Estimates.
- Verify insurance eligibility and benefits, including plan status, network participation, deductibles, copayments, coinsurance, exclusions, and visit limits.
- Determine referral, notification, precertification, and prior-authorization requirements.
- Submit and track authorization requests and assist with denials, peer-to-peer reviews, reconsiderations, and appeals.
- Communicate coverage, benefit, authorization, and patient-responsibility information to patients and staff.
- Provide professional telephone and in-person assistance.
Requirements & Qualifications
Education and experience
- High school graduate or equivalent.
- Medical billing, coding, reimbursement, AAPC, or AHIMA certification preferred.
- 3 to 5 years of healthcare billing, claims processing, reimbursement, payment posting, accounts receivable, eligibility, or prior-authorization experience preferred.
- FQHC experience preferred.
Knowledge and skills
- Working knowledge of healthcare billing, reimbursement, claims processing, collection rules, payer requirements, timely filing limits, contracts, and denial-resolution practices.
- Knowledge of ICD-10, CPT, and HCPCS coding and the relationship among documentation, medical necessity, authorization, claim adjudication, and reimbursement.
- Knowledge of insurance eligibility, benefits, coordination of benefits, referrals, and prior-authorization workflows.
- Proficiency with Microsoft Office, electronic health records, billing systems, payer portals, and standard office equipment.
- Ability to type at least 45 words per minute with accurate 10-key skills.
- Strong attention to detail, analytical and organizational skills, time management, and the ability to work independently.
- Ability to communicate professionally with patients, staff, providers, and payer representatives.
- Ability to pass the state-required background check and pre-hire drug screen.
Location
Alaska, US
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago