Job Description
JOB SUMMARY: Encompasses all aspects of insurance claims processing, patient billing, patient relations and accounts receivable in order to maintain standard benchmarks for billing and for Family Practice groups
SPECIFIC DUTIES AND REQUIREMENTS:
Understanding of managed care issues and complexities.
Understanding of Explanation of Benefits.
Review approved claims as needed for billing accuracy.
Accurately post payments and adjustments.
Work A/R for specific networks. This involves timely follow-up of claims
with calls to insurance carriers and documentation in computer, etc.
Use of a tickler system for timely follow-up of Outlook, correspondence with
insurance companies and patients.
Ability to process reports for the end of day close and scan
Knowledge of insurance denials
Write appropriate appeals
Understand policies to set up payment plan for patient balances.
Report delinquent accounts to Supervisor for Physician approval.
Prepare delinquent accounts for firing prior to being sent to outside collection agency,
Write letters to Texas Department of Insurance as necessary
Extensive knowledge of CPT and ICD-10 codes. Knowledge of timing of new codes and
deletion of old codes.
Accurate entry and timely deletion of pop-up memos on patient and/or family accounts.
Analyze and utilize a “Problem List” for specific network and meet with Provider
Representative and/or IPA as necessary to resolve problems.
Process accounts for patient and/or insurance company refunds when applicable.
Knowledge of correct fee schedule for reimbursement of specific networks.
Meet with Business Office Manager as needed regarding networks and status of accounts.
Knowledge of insurance verification process and how to enter information into system.
Knowledge of Athena One EMR system.
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