Medical Collections Representative

Job Description

This position will perform collections and medical billing for various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) and Patient Billing.

Qualified candidates must be able to

(1) Review accounts for billing accuracy in order to maximize reimbursement.

(2) Persuasive and tenacious follow-up on claims status

(3) Appeal, and re-bill or forward claims for recalculation and / or adjudication as necessary.

Must possess detail knowledge of all medical benefit levels and a have a thorough understanding of Federal, State, and PPO, HMO, and Indemnity Plans structure.

Must meet or exceed the standard level of performance on assigned accounts.

Duties:

Data entry, correct insurance assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy.

Investigate all denied services to determine the reason for the service denial, appeal, if appropriate.

Review and work various reports including aging, adjustments and credit balances.

Comply with Federal and State legislation pertaining to all billing related matters.

Comply with all Safety, Emergency, Hazard, OSHA, HIPAA, Quality Assurance and Administrative Plans, Policies, Guidelines, Protocol, and Standards.

Other duties as assigned.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

Working knowledge of appropriate coding systems; CPT, ICD-9 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.

Proficient in Microsoft Outlook, Excel, Word, the Inter and Intranet and other programs/software as necessary. Working knowledge and hands-on experience of medical billing and reimbursement.

Problem solving skills, using good judgment, attention to detail and follow-through are a must.

Excellent customer service skills; excellent verbal and written communication skills.
Ability to prioritize work, multi-task and time management skills.

Education:

High School Diploma and a minimum of two years related experience or a Bachelor’s degree from a four-year college or university; or equivalent combination of education and experience.

Qualifications

Additional Information

For more information, please contact

Kumar Gaurav