Performs a variety of complex clerical and accounting functions for billing, including verification of invoice information, maintenance of third party billing records, and resolution of a variety of problems. Follows up on submitted claims and billing; resubmits claims or resolves problems.
Essential Duties and Responsibilities
- Processes outbound 837 electronic bill submissions to payors.
- Verifies member Medicare, Commercial and AHCCCS benefits verification and services allowed.
- Works with payors to resolve Prior Authorizations discrepancies.
- Resolves denied and pended billing errors.
- Prepares and reports payor payment trends regarding denials, allowances, net cash receipts.
- Ensures billing systems are setup for optimal billing functions.
- Maintains billing, explanation of benefits, and Receipts filing system and records retention.
- Assists in resolving data validation audit findings.
- Resolves and assists billing team members with denied and pended billing errors.
- Posts receipts and Explanation of Benefits (EOB) via ERA and manual posting.
- Routinely monitors and ensures eligibility segments are documented correctly in NextGen.
- Performs other related duties in accordance with agency growth and changes.
Essential Duties and Responsibilities if Certified Professional Coder
- Answer calls and emails related to coding.
- Review denial notes to determine correctness in diagnosis, modifier & CPT code
- Assist providers in selecting correct CPT codes
- Assist Data Validation Audits
Skills / Requirements
Education: Associates degree in related field preferred; additional experience may substitute for a degree.
Experience: 2-4 years billing & claims processing experience
Certifications: Certified Coder preferred
- Valid Arizona Driver’s license, proof of current insurance and willingness to use personal vehicle.
- Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.
- Bilingual a plus.
- Ability to interact effectively with other service providers.
- Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing/exporting data to/from applications.
- Ability to communicate effectively both orally and in writing
"Equal Opportunity Employer Minorities/Women/Veterans/Disabled"