Responsible for managing and resolving outstanding insurance and patient accounts to support timely reimbursement for healthcare services.
This role reviews unpaid claims, researches denials, communicates with insurance companies and patients, and works closely with billing and clinical staff to improve revenue recovery and reduce accounts receivable aging.
Key responsibilities
- Review and monitor outstanding insurance and patient account balances.
- Follow up with insurance carriers on unpaid, denied, or underpaid claims.
- Investigate claim rejections and denials and take corrective action for resubmission.
- Identify denial trends and recommend process improvements.
- Contact payers to verify claim status, payment information, and authorization requirements.
- Appeal denied claims and submit supporting documentation when needed.
- Document all follow-up activity accurately in the billing system.
- Work aging reports to prioritize and resolve outstanding balances.
- Collaborate with coding, billing, and clinical departments to resolve claim issues.
- Verify insurance coverage, eligibility, and benefits as needed.
- Reconcile payment discrepancies and identify payer reimbursement issues.
- Ensure compliance with HIPAA, payer regulations, and company policies.
- Meet productivity and collection goals established by management.
Requirements & Qualifications
Qualifications
- High school diploma or GED required.
- Associate degree in Healthcare Administration, Medical Billing and Coding, or a related field preferred.
- 1-3 years of medical billing or healthcare accounts receivable experience preferred.
- Experience with commercial insurance, Medicare, Medicaid, and managed care plans.
- Knowledge of denial management and appeals processes.
- Strong understanding of medical billing and revenue cycle management.
- Knowledge of CPT, ICD-10, and HCPCS coding concepts.
- Familiarity with EHR and billing software.
- Excellent verbal and written communication skills.
- Strong analytical and problem-solving abilities.
- Attention to detail and organizational skills.
- Ability to manage multiple accounts and meet deadlines.
- Proficiency with Microsoft Office, especially Excel.
Location
Massachusetts, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 week ago