ESSENTIALS DUTIES AND RESPONSIBILITIES:

·Timely follow-up and resolution on all outstanding A/R including unpaid/underpaid/denied claims for all payers including self-pay to obtain maximum reimbursement.

·Manage daily work queue to prioritize high dollar claim balances.

·Review & work incoming insurance and patient correspondence including refund requests.

·Send appeals when appropriate or provide the requested medical documentation.

·Ability to review medical documentation to justify medical necessity.

·Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.

·Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.

·Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.

·Negotiate payment amounts for procedures with Third Party Administrators fo...