• Submits all clean claims to the appropriate insurance payer the same day the claim is loaded into the Editor with the exception of weekends and Holidays
• Reviews payer EOB’s but not limited to payment accuracy, patient liability, updating the financial class, notify commercial biller to submit secondary or tertiary insurance, and appeal grievance.
• Files appeals on denied claims and/or forwards to the Nurse Auditor for review/appeal
• Enter denials on the Denial Log
• Enter the USPS tracking number in the Patient Accounts system
• Enter the USPS delivered date in the Patient Accounts system
• Contact payer to ensure an appeal was received
• Maintain better than an 80% clean claim average.
• Attach but not limited to the medical records, implant invoice, and itemized bill to the claim before billing if applicable
• Process incoming mail correspondence from the payers within 3 business days
• Work assigned billing reports within 2 business days
• Work the rejection report daily to resolve problem accounts
• Follow up with the payer via phone and/or the website for the status of outstanding claims
• Respond to patient inquiries within 2 business days
• Respond to interdepartmental inquiries within 2 business days
• Respond to payer requests within 2 business days
• Respond to emails within 2 business days
• Submit newborn notifications if applicable
• Review/resolve the accounts on the Unbilled Report daily (accounts that are on hold and haven’t been processed by the editor).
• Enter detailed notes explaining account activity in the Patient Accounts system
• Process payments over the phone if applicable
• Print UB and 1500 hardcopy claims when required by the payer
• Submit primary, secondary and tertiary claims before the timely filing deadline
• Research late charges to determine the cause; inform supervisor of regular occurrences and trends

• Report A/R account trending issues to the Supervisor and the Director of Patient Financial Services
• Follow up with all insurance companies within 30 days of billing if there is no payment on the account
• Work the eScan reports timely if applicable
• Forward patient complaints regarding care to the supervisor for entry into the appropriate resolution pathway
• Notify supervisor of payers that accept electronic billing currently billed hard copy

Education

• High School or better

Licenses & Certifications

• C-Heartsaver