Responsible for auditing medical, dental, behavioral, and hospital insurance claims for accuracy and timely electronic submission through the practice management system. This role also handles follow-up on outstanding claims and maintains accurate accounts receivable records.
Key duties include:
- Audit insurance claims for accuracy and timely electronic submission
- Apply insurance and other payments, along with necessary adjustments, to patient accounts
- Monitor accounts receivable aging reports and identify accounts requiring attention
- Stay current on billing requirements for Medicaid, Medicare, CHIP, commercial payers, and other third-party payers
- Review insurance accounts and request adjustments and/or refunds when appropriate
- Appeal and/or resubmit denied or rejected claims
- Communicate accounts receivable issues to the supervisor and relevant staff
- Work with health care services staff to address incomplete or incorrect billing information
- Look for opportunities to improve accounts receivable processes and daily efficiency
- Perform additional duties as assigned
Requirements & Qualifications
Required qualifications:
- High school diploma or equivalent
- Two years of work experience in a medical office environment, including claims submission and appeals with Medicaid, Medicare, managed care organizations, commercial payers, and other third-party payers
- Experience with medical and dental terminology and procedural/diagnosis coding, including ICD, CPT, HCPCS, and CDT
- Knowledge of HIPAA compliance requirements
- Strong oral and written communication skills
- Ability to handle multiple projects simultaneously
- Proficiency with computers, copier, fax, and 10-key machine
- Experience with Microsoft Office and practice management system software
- Basic accounting knowledge
- Ability to work professionally with the public and all levels of the organization
Preferred qualifications:
- Experience in a community health center
- Knowledge of billing software programs
- Knowledge of medical terminology and coding, including CPT, ICD-9, ICD-10, and HCPCS
- Knowledge of medical billing and collection practices
- Understanding of governmental billing regulations and third-party reimbursement policies
- Ability to read and interpret EOBs in detail
- Experience in training, team building, and customer service
Location
Richmond, Texas, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
No
Posted
1 month ago
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