Description: Responsibilities: • Job responsibilities include those listed in competencies document • Maintains a professional image and exhibits excellent customer relations to patients, visitors, physicians, and co-workers in accordance with our Service Excellence Standards and Core Values. • Responsible for efficient and effective follow-up on third party payers to determine why payment has not been received within a specified amount of time. • Reviews and interprets payer remittances for the purpose of verifying accuracy of payments, adjustments and to determine appropriate action to be taken on denied claims, per guidelines. • Initiates appeals for denied claims per payer guidelines. • Reviews patient account files as necessary for accuracy of information, necessary signatures, pre-certification, insurance benefits, and deposits made. • Submit electronic and hard copy claims in an accurate and timely manner and makes all necessary corrections to the claims that do not pass the billing edits and payer requirements. • Contact payers for status of unpaid claims and research to ensure that questions and requests for information are addressed in a timely and professional manner to facilitate resolution and reimbursement. • Assure timely, effective, and thorough management of claims to ensure full, expected reimbursement for services provided. • Reviews and resolves credit balances in an accurate and timely manner according to policy. • Obtain patient payments and/or set up payment plans according to policy and document any payment arrangements on patient account. Prepares accounts with outstanding balances for the collection agency. • Understands and complies with processes for corrected claims, per payer guidelines. • Maintains knowledge of payor guidelines for assigned specialties. • Prioritize claims based on aging and outstanding dollar amounts or as directed by management. • Answer telephone calls from patients and other callers promptly and with courtesy, demonstrating service excellence as a top priority. • Communicates payer trends or problems identified as impacting reimbursement to the management team. • Manage their time to meet collection goals and productivity standards as defined by the management team. • Participates in quarterly AR meetings with the assigned Medical Practices and educational sessions. • Ability to look up ICD-10 and CPT Treatment codes from online service or using traditional coding reference. • Regularly meets with the Billing Manager to discuss and resolve reimbursement issues or billing obstacles. • Travel may be required to off-site locations at times. Qualifications: • At least 3 years’ experience in a computerized physician office or hospital setting in insurance, billing and reimbursement. Thorough knowledge of regulations relating to Medicare, Medicaid, Worker’s Compensation, and commercial insurance. • Demonstrates the ability to work independently and prioritize a heavy workload in a fast paced environment. Strong emotional maturity. Strong time management, organizational and written/verbal communication skills. Must have strong problem solving, attention to detail and accuracy skills. • Proficiency in Microsoft Word, Outlook and Excel. Proficiency in Math and Medical Terminology. Ability to maintain highly sensitive and confidential information. Requirements: Degrees: High School Diploma/GED