Evaluate new and existing payers/networks and their fee schedule for participation.
Proactively monitors payor medical policy updates and ensures those are applied to daily processes.
Collaborates with revenue and credentialing on enrollment of NPI’s for EDI submissions and imports of ERNs into billing software.
Inputs all new insurance payors contracted/non-contracted in billing software.
Ensures operations are conducted in a manner that is consistent with overall department protocol, and in compliance with Federal, State, and payer regulations, guidelines, and requirements.
Maintains a working knowledge of all health information management issues such as HIPAA and all health regulations.
Reports all concerns or issues directly to Director of Revenue.
Qualifications:
Experience:
Minimum of four (5) years Medical Insurance/Healthcare Billing and Collections experience in a medical practice or health system, with a deep understanding of insurance medical/fee schedule policies and regulations experience preferred.
Knowledge/Abilities:
Strong knowledge of payor reimbursement and medical policies
Strong excel, analytical, problem-solving, and communication skills.
Detailed-oriented with the ability to work independently and meet deadlines.
Working knowledge of CPT and ICD9 codes, HCFA 1500, UB04 claim forms, HIPAA, billing and insurance regulations, medical terminology, insurance benefits and appeal processes.
Up to date with health information technologies and applications.
Must be proficient in Microsoft Office, including Outlook, Word, and Excel.
Ability to communicate effectively in writing, over the telephone, and in person.
Work Environment:
Position is in well-lighted office environment. Occasional evening and weekend work may be required.
