Reviews and audits accounts located in contract management system on a daily basis to resolve and maintain collection status on an account prior to escalating to Team Lead for further review. Reviews and processes commercial accounts through contract/denial management system. Verifies eligibility, corrects and resubmits claim, and files third party insurances as necessary by adding/updating insurance information to host system. Utilizes denial management system and responds to requests from insurance carrier for additional information necessary to process claims. Reviews EOB's in contract management system and determines accurate account balance, detailed denial description, and applicable appeal process. Identifies and corrects transactions, such as invalid insurance information, incorrect charges, and posting errors, in host system. Resolves claims processing dispute as it related to following denials/correspondence received.
Minimum Knowledge, Skills and Experience required:
Education: - High school diploma or GED.
Experience: 6 months to 1year working experience of Hospital or Physician office billing and collection processes including producing account appeals with positive outcomes strongly preferred. Proven applicable experience working in an environment that utilizes electronic billing, internal report archives, and tools for applicable database management strongly preferred. Proven applicable experience of preparing complex correspondence to resolve accounts strongly preferred.
Additional Skills: General application knowledge of EXCEL and WORD.