Medical Billing and AR Specialist

Job Description

Primary Responsibilities:

Responsible for obtaining authorization for pain management procedures from insurance companies.

Responsible for Billing and Coding, Pre Certification and Credentialing

Responsible for collecting, outstanding account payments.

Responsible for following up with insurance companies and patient accounts.

Has knowledge of commonly-used concepts, practices, and procedures within the Medical Billing and Medical Insurance field

Complete multiple tasks simultaneously

Work independently, detail oriented and organized

Proficient w/ government and commercial Understanding of insurance websites and form fields for authorization submission

Maintain up to date information on various insurance companies and any relevant changes

Keeps management informed of changes or issues

Completes other tasks or responsibilities as assigned

Responsible to reduce aged A/R.

Analyze Explanation of Benefits (EOB’s) and Correspondence to identify zero pays and underpayments.

Responsible to follow-up with healthcare insurance companies on outstanding medical claims and appeals.

Maintain open communication with the insurance verification team, billing department and office support staff.

Conduct collection actions and provide resolution for complex accounts.

Provide supporting documentation that supports collection actions.

This position is responsible for obtaining and completing all insurance pre-certifications and authorizations as required for various clinical procedures.

Determines necessity for pre-certification and coordinates with insurance companies, patients and clinical staff to obtain information.

Maintains complete and accurate documentation in patient charts.

Develops and maintains effective relations with insurance companies, physicians and medical office staff.

Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow.

This position requires the ability to work with minimal supervision.

Monitor new patient report and maintain organized list with status of pre-certification process.

Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information.

Check insurance payment policy for scheduled procedures and obtain prior authorization when required.

Verify receipt of all necessary pre-authorization documents prior to procedure

Communicate effectively with the facility in which the procedure will be performed as needed.

Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.

Notify primary care physician for managed care plans that require PCP authorization.

Serve as a resource on insurance, billing and customer service for reception.