Primary Duties
1. Posts charges for all providers (medical, dental, behavioral health) and ensures they are posted to the highest level of specificity with appropriate modifiers, place of service codes, CPT codes, etc.
2. Responsible for sending all claims to insurance or third party payers and working the edits and rejections to ensure they are received by the payer.
3. Posts payments both insurance/third party and patient/self-pay accurately, as per explanation of benefits, 835 files or statements received and reconciling back to bank statements to ensure the payment has been received.
4. Works denied claims and sends appeals to ensure we are capturing revenue as per insurance/payment policies.
5. Performs claim follow-up to ensure payers are processing timely and accounts receivable is within normal range, as per performance indicators for clinics of this stature.
6. Conducts charge reconciliation at month end to ensure all charges/encounters are captured for the month to ensure a clean month end.
7. Performs payments audits to ensure accurate payments rates, as per our payer contracts, as well as reviewing charges to ensure rates are set correctly relative to payments.
8. Answers phone calls from patients regarding billing, statement or insurance questions and working with patients to ensure their needs are met.
9. Collects delinquent accounts by establishing payment arrangements with patients, monitoring payments and following up with patients when payment lapses occur.
10. Processes statements and reviewing for accuracy.
11. Identifies/verifies patient's insurance coverage or other sources of payment and works closely with CSR staff.
12. Performs other duties as assigned.