An Exclusion List (LEIE) check verification by the Office of Inspector General U.S Department of Health & Human Services (OIG), and the System for Award Management (SAM) is performed on all employees prior to employment.
Radiology Regional Center is seeking a Medical Biller/Claims Specialist with experience in working with medical claims to work in our business office in Fort Myers. Under the direction of the Claims Resolution Supervisor and Business Office Manager, the Medical Biller performs duties directly involving follow-up of outstanding claims, research denials, submit appeals, work claims correspondence, posting patient and insurance payments, answer patient inquiry phone calls, and identify insurance and patient payment refunds. The position will apply medical insurance, self-pay and medical billing techniques to successfully resolve outstanding patient balances.
Coordinates complex accounts and systems to resolve issues through the understanding and application of medical billing and collection techniques.
Reviews A/R aging and contact insurance companies to determine status of overdue and outstanding insurance claims to resolve claims in a timely manner.
Identifies key issues and takes appropriate action to ensure revenue maximization on individual accounts.
Must be able to obtain information to respond to difficult patient and medical insurance inquiries.
Communicates with patients, physicians, insurance companies and other departments to resolve accounts.
Demonstrates a working knowledge of insurance EOBs and claim denials with the ability to explain coverage details to patients.
Responds to inquiries on various subjects relating to billing, charges, account balance, insurance and other claims resolution areas. Performs appropriate follow-up.
Apply billing and collection knowledge and practices required for all insurance payors to assure proper and maximum reimbursement.
Recommends and prepares delinquent accounts for referral to collection agencies or recommends account write-offs to management.
Reports any claim denial problems to management for review.
Works system collection reports.
Prepare appeals to insurance payers for denied claims. Perform regular follow-up on appeals.
Post patient and insurance payments in manual or ERS mode as applicable.
Review, correct, and properly disposition all payment exceptions during the payment posting process.
Identify true patient credit balances and insurance payment refund requests while working A/R and prepare the refund for payment through the billing system.
Prints and mails claim forms and statements or processed through EDI as requested.
Ensures all notices received from the bankruptcy courts are handled in compliance with bankruptcy laws and regulations.
Understand Medical Business Office functions to include EDI, insurance and self-pay collections, cash posting, maintaining support files, and an understanding of all related departments.
Comply with federal and state laws and regulations pertinent to patient care rights and billing and collections.
Two years experience in a medical office setting to include direct experience with: charge entry, payment posting, authorizations and insurance and self-pay account collections
Familiarity with computer based billing & A/R systems
Proficiency in keyboard and ten-key pad entry
Interpersonal skills to function in a team environment
Ability to process high volume of data
Ability to adapt to various departmental procedures on a rotating basis