Position Overview This role is responsible for the accurate and timely submission of medical claims to insurance providers across a variety of healthcare settings. The individual will ensure payments for medical services are received promptly and may act as a liaison between healthcare providers, patients, and insurance companies.
Key Responsibilities - Maintain a safe and clean work environment, adhering to safety and infection control standards.
- Review patient billing information for accuracy and completeness, obtaining missing details as needed.
- Identify appropriate insurance parties to bill, including secondary and tertiary insurers.
- Utilize electronic health record (EHR) systems to perform billing tasks and maintain compliant medical records.
- Process claims and apply payments or credits accordingly.
- Verify insurance payments for accuracy and contract compliance.
- Investigate and resolve denied or partially paid claims by collaborating with involved parties.
- Manage assigned accounts to ensure timely payment of outstanding claims and follow up as necessary.
- Communicate effectively with healthcare providers, patients, and insurance representatives to clarify billing issues.
- Consult supervisors and team members to address billing and collection challenges.
- Follow established policies and procedures to maintain operational quality and escalate compliance concerns appropriately.
- Prepare reports and documentation as required.
- Perform administrative duties such as answering phones, faxing, filing confidential documents, and using email and internet tools.
- Deliver professional and courteous customer service to both internal and external stakeholders.
- Collaborate as a team member while meeting deadlines and productivity goals.
Qualifications - Minimum of one year experience posting in a healthcare environment.
- Strong customer service skills with demonstrated leadership, teamwork, and cooperation.
- High ethical standards and professional integrity.
- Understanding of medical and surgical terminology.
- Knowledge and compliance with HIPAA regulations, maintaining strict confidentiality.
- Proficient with email, internet research, and payer websites.
- Preferred experience with billing software such as GE Centricity and SRS Caretracker.
- Excellent written, oral, and interpersonal communication skills; able to present ideas clearly and professionally.
- Highly self-motivated, detail-oriented, and able to prioritize tasks effectively in a fast-paced environment.
- Ability to interpret complex documents and respond appropriately to sensitive inquiries or complaints.
Education - High school diploma or equivalent required.
- Associate's Degree in Business Administration preferred.
Certifications - Certified Medical Reimbursement Specialist (CMRS) certification preferred.
All candidates must successfully complete a physical evaluation, drug screening, and background checks prior to employment. This position is based in a regional healthcare setting within the Pacific Southwest region of the United States.