01Key Responsibilities
- Review and follow up on unpaid or denied insurance claims (primary and secondary).
- Analyze Explanation of Benefits (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. .
