Responsible for working healthcare accounts receivable related to coding denials and edits for professional and hospital-based claims. The role supports timely collections of outstanding government and commercial receivables, follows up on denied or unpaid claims, and helps resolve issues across the reimbursement cycle.
Key responsibilities include:
- Work denials and appeals, assigning edits as needed.
- Assign accurate codes for inpatient and outpatient physician and hospital-based claims.
- Verify eligibility and authorization information.
- Update patient demographics and insurance information.
- Research unpaid or denied claims and monitor missing information.
- Review EOBs, payment adjustments, and underpayments.
- Contact payers to secure claim payment.
- Gather medical documentation and billing guidelines as needed.
- Write technical appeal letters.
- Prepare claims for clinical audit processing when denials involve authorization, coding, level of care, or length of stay.
Requirements & Qualifications
- 3+ years of healthcare accounts receivable experience.
- 2+ years of healthcare and/or insurance billing and processing experience.
- Active AAPC or AMHIMA certification required.
- Experience with professional physician and hospital facility claims.
- Ability to read and interpret EOBs.
- Knowledge of UB-04 and HCFA 1500 forms.
- High school diploma required.
- Strong Outlook, Excel, and Word skills.
- Strong communication, interpersonal, analytical, and critical thinking skills.
- Ability to work independently.
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
3 weeks ago
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