This position is responsible for the resolution of A/R in a complete, accurate, and timely manner while verifying that industry rules and regulations, including, local, state, and federal regulations, regarding billing and collection practices are followed; as well as with established internal policy and procedure.

Primary Responsibilities:

• Reviews medical record documentation to identify services provided by physicians and mid-level providers as it pertains to claims that are being filed


• Verifies appropriate CPT, ICD, and HCPCS codes to accurately file claims for the physician service using the medical record as supporting documentation


• Performs corrections for patient registration information that includes, but is not limited to, patient demographics and insurance information


• Responsible for working claim rejections in a timely manner


• Receives and interprets Explanation of Benefits (EOB) that supports payments from Insurance Carriers, Able to apply correctly to claims/ fee billed


• Processes incoming EOBs to ensure timely insurance filing. May require correction of data originally submitted for a claim or Coordination of Benefits with secondary insurance


• Responsible for processing payments, adjustments, and denials according to established guidelines


• Responsible for reviewing insurance payer reimbursements for correct contractual allowable amounts


• Responsible for reconciling transactions to ensure that payments are balanced


• Responsible for reducing accounts receivables by accurately and thoroughly working assigned accounts in accordance with established policy and procedures


• Responsible for keeping current with changes in their respective payer’s policies and procedures

Required Qualifications:

• High school diploma or GED equivalent


• Two or more years of relevant experience in the healthcare industry, with a focus on medical terminology and ICD/CPT coding preferred


• Strong attention to detail and professional customer service skills


• Intermediate level with Microsoft Office applications

Preferred Qualifications:

• Knowledge of submission and re-submission of medical claims


• Government and commercial policies and procedures knowledge.


• Knowledge of ICD, CPT codes and HCPCS coding


• HIPAA compliance rules and regulations


• Skill in the operation of billing software and office equipment


• Skill in processing claims efficiently and on a timely basis