Verify/obtain eligibility and/or authorization utilizing payer web sites, client eligibility systems or via phone with the insurance carrier/providersResearch/ Status unpaid or denied claimsMonitor claims for missing information, authorization, and control numbers (ICN//DCN)Research EOBs for payments or adjustments to resolve claimContacts payers via phone or written correspondence to secure payment of claims Access client systems for payment, patient, claim and data infoFollows guidelines for prioritization, timely filing deadlines, and notation protocols within appropriate systemsSecure needed medical documentation required or requested by third party insurance carriers.Maintain confidentiality of patient information in accordance with insurance collection guidelines and corporate policy and procedurePerform other related duties as requiredUtilize provider billing manuals to obtain billing guidelines and requirements.Write appeal letters for technical appealsVerifies accuracy of underpayments utilizing contracts and claims data.Prepares claims for clinical audit processing in the case of authorization, coding, level of care and/or length of stay denialsUtilizes reports for analysis and to monitor follow up activities and prioritizationAssists organization with working through special projects as neededSME for colleagues and provide direction for resolution of accountsAssists in new hire trainingAssists in content building of training materialsQualifications & Competencies 3+ years of medical collections/billing experience2+ years of experience as a Team LeaderIntermediate knowledge of ICD-10, CPT, HCPCS and NCCIExpert knowledge of third-party billing guidelinesExpert knowledge of billing claim forms (UB04/1500)Expert knowledge of payor contractsWorking Knowledge of Microsoft Word and ExcelIntermediate working knowledge of health information systems (i.e., EMR, Claim Scrubbers, Patient Accounting Systems, etc.)Must be willing to work onsite.Preferred Qualifications Working knowledge of one or more of the following Patient accounting systems – EPIC, Cerner, STAR, Meditech, CPSI, Invision, PBAR, All Scripts or ParagonPrior team lead experienceWorking knowledge of DDE Medicare claim systemKnowledge of government rules and regulations Cost of Outsourcing: Strategies for Maximizing ROI March 15, 2024
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Founded in 2007, VISAYA KPO is a Filipino firm dedicated to top-tier service, blending innovation and quality with the cultural essence of 'malasakit' to foster lasting client relationships.
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