Offer summary

Qualifications:

High school diploma or equivalent required; college education or trade school preferred., Previous experience in Medical Billing and Collections, ideally with at least eighteen months of experience., Proficient in using email and Internet applications, with knowledge of practice management and Microsoft software., Strong understanding of Explanation of Benefits forms, insurance billing processes, and basic knowledge of CPT and ICD-10 coding..

Key responsabilities:

Review claims to identify insurance overadjustments and transfer balances as needed.

Follow up on claims with credit balances to determine their validity in a timely manner.

Monitor and respond to communication inquiries from the field within a 48-hour timeframe.

Build and maintain relationships with internal and external personnel while attending required training and meetings.

Job description

Job Details

Job Location: 59-03-Cynthiana - Cynthiana , KY

Salary Range: Undisclosed

Description

Review prior postings of claims to determine insurance overadjustments or balances that may need to be transferred using Explanation of Benefits (EOB) documents and reports. RCM Adjustments Specialist are assigned specific books of business based on Financial Class and Payers. Work to support the field related to claim false credits.

Daily Duties

Follows up on claims with credits balance to determine true or false credit within a timely manner
Transfer (convey) balances to the appropriate payer or patient level per EOB or next financial responsibility.
Monitor, review, and respond to Hub (field) communication inquiries within the 48 hour requirement.

Account Follow-Up

Using data from the monthly aged accounts receivable report or daily credits reports, correct overadjustments to balance the claim.
Builds and Maintain relationships with personnel from internal and external departments.
Meets with Team Lead/Supervisor regularly to discuss and solve reimbursement and insurance follow up concerns

Other

Maintains patient confidentiality; complies with HIPAA and compliance guidelines established by the practice.
Maintains detailed knowledge of practice management and other computer software as it relates to job functions.
Attends OSHA, HIPAA, and OIG training programs as required.
Attends all meetings as requested including regular staff meetings.
Attends Medicare and other continuing education courses as requested. Pursue and participate in education to remain current with changes in the Healthcare industry.
Performs any additional duties as requested by the CRO, RCM VP, and/or RCM Director.
Completes all assigned AP training (such as CPR, OSHA, HIPAA, Compliance, Information Security, others) within designated timeframes.
Complies with Allergy Partners and respective hub/department policies and reports incidents of policy violations to a Supervisor/Manager/Director, Department of Compliance & Privacy or via the AP EthicsPoint hotline.

Models the AP Code of Conduct and demonstrates a commitment to the AP Compliance Program, standards and policies.

Qualifications

EDUCATIONAL REQUIREMENTS:

High school diploma, or equivalent, required
College education or trade school preferred

QUALIFICATIONS AND EXPERIENCE:

Previous Medical Billing and Collections experience preferred. Preference for those with a minimum of eighteen months experience.
Comfortable using email and interacting with Internet applications
Knowledge of practice management and Microsoft processing software
Proven understanding of Explanation of Benefits forms, claim forms and the insurance billing process
Working knowledge of managed care, commercial insurance, Medicare, and Medicaid reimbursement
Basic knowledge of CPT and ICD-10 coding
Strong written and verbal communication skills