Medial Billing Operations Manager
2 weeks ago
We are seeking a highly skilled Medical Billing Specialist to join our team. This key role is accountable for monitoring the status of medical claims, thoroughly investigating rejections and denials, and diligently documenting related account activities.
The Medical Biller will be tasked with the critical responsibility of posting adjustments and managing collections for a diverse range of payers, including Medicare, Medicaid, commercial insurance, and Workers' Compensation.
This position requires a deep understanding of various eligibility requirements and payment methodologies, as well as a keen ability to record contractual adjustments in compliance with government regulations and payer contracts.
Responsibilities- Perform verification of eligibility and benefits to ensure accurate patient coverage.
- Review and submit claims in a timely and compliant manner.
- Obtain prior authorizations to support smooth claim approvals.
- Monitor the status of medical claims and conduct A/R follow-up to ensure prompt and accurate payment.
- Research and resolve claim rejections and denials, implementing measures to prevent future occurrences.
- Generate and submit patient statements.
- Document all account activities accurately and in a timely manner.
- Post manual payments, apply adjustments, and manage collections from various types of payers.
- Understand and apply Medicare, Medicaid, and commercial insurance eligibility requirements and payment methodologies.
- Correctly record contractual adjustments based on payer contracts and government regulations.
- At least 2 years of strong background in revenue cycle processes, including eligibility and benefits verification, charge review, claims submission, AR follow-up and denial management, collections, prior authorizations, payment posting, and handling medical records requests.
- Candidates must demonstrate an ability to work collaboratively with team members and healthcare providers.
- Candidates must be able to function in a fast-paced work environment and handle occasional periods of above-average pressure.
- Excellent customer service skills are necessary, as the role involves interacting with various stakeholders, including patients, insurance companies, and healthcare providers.
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