Job Description

We are seeking a highly experienced Medical Billing Revenue Cycle Management specialist to join our medical billing team. The ideal candidate will have a strong understanding of medical billing processes and terminology, experience in follow-up for Out-Of-Network providers, ensuring accurate and timely follow-up on billed claims.

Roles & Responsibilities:

• Responsible for claims follow-up, Professional and Facility, from claim submission until final payment
• Communicate with insurance companies regarding claim denials or underpayments
• Utilize Payer Online Portals such as Availity, Cignaforhcp, UHC, Navinet, Emblem for claims status and eligibility verification
• Send Medical Records to payers, filing reconsiderations and appeals
• Utilize providers EMR’s to obtain Medical Records
• Reading and understanding various payers EOB’s
• Posting payments, writing off balances and sending statements to patients, when necessary
• Communicating with 3rd party payers such as Multiplan, MARS and Zelis regarding OON claim negotiations.
• Follow up on Pre-negotiated Agreements a/k/a Single Case Agreements
• Review and verify accuracy of billing data utilizing Optum EncoderPro
• Utilize medical collection systems to track and collect payments
• Ensure compliance with all relevant coding and billing regulations
• Effectively resolve complex issues, including payment research, payment recoupments
• Effectively communicate issues to management, including payer, system or escalated account issues as well as develop solutions

Experience & Requirements:

• Knowledge in Multi-Specialty coding - CPT and ICD codes for many different specialties
• Experience working with medical billing software like Imagine and ADS
• Familiar with Gap (Network Deficiency) exception and prior authorizations process
• Familiar with Federal IDR arbitrations process
• Familiar with OON Provider Registration Process with various Payers
• Knowledge of medical terminology (Hicfa, UB04, Tax ID, NPI)
• Strong attention to detail and persuasive telephone skills
• Excellent communication and interpersonal skills
• Solid skill with Microsoft Office applications: Word, Excel, Teams, Power BI reporting, Zendesk
• High School Diploma or equivalent
• Must have a minimum of 3 years’ experience in collections

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Employee discount program
• Health insurance
• Flexible Spending Account
• Life insurance
• Paid time off
• Vision insurance
• Employee Referral Bonus

Work Location: In person

Job Type: Full-time

Pay: $22.00 - $25.00 per hour

Expected hours: 40 per week

Schedule: 8 hour shift

Skills Required

Experience Required

3-4 years