Responsible for billing third-party payers through a claims processing vendor and/or appealing denied professional and/or hospital claims. The role identifies billing issues affecting hospital and physician claims/accounts, takes appropriate action to support timely claim filing, and performs follow-up activities to resolve reimbursement issues and support account resolution.
Key responsibilities include:
- Billing payers and/or clients for hospital and professional patient accounts
- Resolving payer rejections and submitting corrected claims
- Performing detailed follow-up on assigned accounts
- Responding to correspondence in a timely manner
- Identifying denials and underpayments for appeal
- Reviewing, researching, and processing denied claims
- Appealing claims according to policy and procedure
- Updating account information in Epic Resolute
- Processing account adjustments and issuing refunds when appropriate
- Validating the accuracy of payments and adjustments
- Maintaining productivity and accuracy standards
- Assisting with policy and procedure development
- Supporting team activities and training new employees
Requirements & Qualifications
Minimum qualifications:
- Two years of financial experience, or one year of patient accounts experience
Preferred qualifications:
- 2+ years of experience in hospital billing denials resolution with Medicaid payers
- 2+ years of experience in medical billing and revenue cycle operations, including claims, EOBs/remits, cash posting, eligibility/registration, and coding
- 2+ years of experience working with various payers and payer websites
- 2+ years of experience utilizing work queues and documenting account notes
- 2+ years of analytical and problem-solving skills
- Basic understanding of CPT, ICD-9, HCPCS, modifier coding, and POS requirements
- Knowledge of state and federal payer billing regulations
- Ability to work with Epic Resolute and other billing systems
Location
Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
1 month ago