MAJOR FUNCTION:
Ensures that all charges billed are paid accurately and within the required time parameters by identifying and taking the required steps to investigate and resolve payment denials and other payment issues. 

QUALIIFCATIONS:

Education & Experience:

High School diploma or equivalent required.1-2 years medical physician billing or collections required.

Certification/Licensure: 

AHIMA Certified Coder, AAPC Certified Coder, or coding experience a plus.

Knowledge & Skills:

Knowledge of Windows-based software applications (Word, Excel, etc.).

Position Responsibilities

• Investigates and takes the appropriate steps to address and resolve payment denials and

incorrectly paid accounts.

• On a daily basis, reviews the denial que and researches and resolves these claims issues

contacting the pertinent parties by telephone or insurance website.

• Reviews the que on a daily basis to capture "no response" claims and to follow-up or reexamine claims "with response" at least every 30 days until the account is resolved

appropriately.

• Identifies practice and/or payer-specific trends that cause an increase in the A/R aging

and works with leadership to resolve.

• Reviews Revenue Manager for claim rejections (or claim edits) – electronic claims that are

flagged for incorrect or invalid information on the original electronic claim. Determines

reason for rejection and identifies claim form locators causing the errors. Corrects

information submitted internally causing the rejection and resubmits claim. Escalates

issues to supervisor that require further investigation.

• Updates Cerner Millenium with notes to reflect account status and collection activity.

• Provides timely communication to leadership with regards to payer issues and updates.

Physical Requirements: 
N: Never       O: Occasionally (<20%)       F: Frequently (20%-80%)       C: Constantly (>80%)     Lifting <20lbsOStandingOSittingCLifting 20-50lbsNClimbingNKneelingNLifting>50lbsNCrouchingNReachingOCarryingOHearingCWalkingOPushingNTalkingCVisionC      Environmental Conditions:     NoiseNVaried TemperaturesOCleaning AgentsNNoxious odorsNPatient ExposureNOperative EquipmentN