Essential Duties and Responsibilities
- Obtaining referrals and pre-authorizations as required for procedures.
- Checking eligibility and benefits verification for treatments, hospitalizations, and procedures.
- Reviewing patient bills for accuracy and completeness and obtaining any missing information.
- Preparing, reviewing, and transmitting claims using billing software, including electronic and paper claim processing.
- Following up on unpaid claims within the standard billing cycle timeframe.
- Checking each insurance payment for accuracy and compliance with contract discounts. Calling insurance companies regarding any discrepancy in payments if necessary.
- Identifying and billing secondary or tertiary insurances.
- Reviewing accounts for insurance of patient follow-up.
- Researching and appealing denied claims.
- Answering all patient or insurance telephone inquiries pertaining to assigned accounts.
- Setting up patient payment plans and work collection accounts.
- Updating billing software with rate changes.
- Updating cash spreadsheets and running collection reports. Knowledge, Skills, and Abilities
- Proficiency in the following areas is preferred:
- Knowledge of insurance guidelines, including HMO/PPO, Medicare, Medicaid, and other payer requirements and systems.
- Competent use of computer systems, software, and ten key calculators.
- Familiarity with CPT and ICD-10 Coding.
- Effective communication abilities for phone contacts with insurance payers to resolve issues.
- Customer service for interacting with patients about medical claims and payments, including communicating with patients and family members of diverse ages and backgrounds.
- Ability to work well in a team environment. Being able to triage priorities, delegate tasks if needed, and handle conflict in a reasonable fashion.
- Problem-solving skills to research and resolve discrepancies, denials, appeals, and collections.
- A calm manner and patience worked with patients or insurers during this process.
- Knowledge of accounting and bookkeeping procedures.
- Knowledge of medical terminology likely to be encountered in medical claims.
- Maintaining patient confidentiality as per the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
- Ability to multitask
Interested candidates can share your updated resumes with firstname.lastname@example.org along with following mandatory details…
- Relevant Experience:
- Current & Expected CTC:
- Notice period:
- Reason for job change:
Human Resources ESN Technologies (India) Pvt. Ltd.