01Key Responsibilities
Review and follow up on unpaid or denied insurance claims (primary and secondary).
Analyze Explanation of Advantages (EOBs) and Remittance Advice (RA) to determine appropriate action.
Contact insurance companies to resolve claims issues and secure payments.
Work denials and rejections in a timely manner and re-submit corrected claims as needed.
Perform AR follow-up via phone calls, portals, and payer websites.
Ensure compliance with payer-specific billing requirements and HIPAA regulations.
Collaborate with coding and billing teams to resolve discrepancies or missing documentation.
Update claim status and notes in the billing system (e.g., EPIC, Kareo, eClinicalWorks).
Meet productivity and quality targets (e.g., number of claims worked per day, resolution rate).
02Requirements
High School Diploma or equivalent (Associate's degree preferred).
15 years of experience in Physician billing, with emphasis on CMS-1500 claim processing.
Knowledge of Medicare, Medicaid, and commercial insurance guidelines.
Familiarity with EHR and billing systems (e.g., Epic, Cerner, Meditech).
Detail-oriented with robust problem-solving skills.
Ability to work independently and meet deadlines. .
