Summary of Duties
Responsible for the billing, collecting, and working of accounts from third party payors and patients/residents to resolution. Completes all necessary insurance claim requirements. Followsup on unpaid claims. Responds to inquiries regarding accounts, providing satisfactory explanation of patient/resident charges and/or account status.
Essential Job Functions
- Reviews and prepares insurance billing for completeness and accuracy, making necessary edits and corrections to claims prior to submission.
- Contacts patient/resident, employer, etc. to obtain necessary information to file insurance claims.
- Processes late charges and other account adjustments to patient accounts.
- Reviews and works audit trails on outstanding accounts.
- Handles follow-up of unpaid balances with insurance companies and patients/residents by use of statements, collection letters, re-bills, or phone contact.
- Collects charges not covered by insurance or makes satisfactory payment arrangements.
- Reports bankruptcy and estate claims to collection attorney and adjusts account as necessary.
- Handles follow-up for outstanding balance due on past due contractual payment agreements.
- Records and documents all activity occurring on an account.
- Processes/posts remittances from Medicare, Blue Cross/Blue Shield, Medicaid, and other major third party payors. Processes remittance rejections in accordance with established guidelines.
- Processes/posts payments from patients/residents.
- Balances and audits work as required.
- Investigates credit balance accounts, completes requests for processing.
- Trains and assists facility personnel in computer programs used in billing office procedures as assigned.
- Receives and resolves inquiry from patients/residents, their representatives, insurance companies, and attorneys.Documents discussions regarding an account.
- Performs general office duties to include answering telephones, maintaining supplies and processing return mail.
- Provides support for record maintenance and office filing requirements.
- Performs research of Medicare bad debts, daily census, month end and other periodic reports as requested.
- Performs other responsibilities and special projects as directed.
Education & Experience
High school diploma or equivalent required. Minimum of one (1) year of related experience in a medical business office environment required.
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