Billing Denials Representative

CompuNet Clinical Laboratories•Moraine, OH

13h•Hybrid

About The Position

Under the supervision of the Billing Department Manager, this role performs daily account processing tasks for the Billing Department. This includes billing data entry, third-party billing and follow-up, reviewing denials and resubmitting claims, and handling calls to patients and clients while maintaining positive relationships. The position requires strong customer service skills, adherence to departmental processes and compliance regulations, and effective communication with internal and external stakeholders. Responsibilities also include accurate order entry, payment application, investigating un-adjudicated claims, processing Medicare denials, and managing high call volumes in a fast-paced environment.

Requirements

High school graduate or equivalent required.
Minimum of 1 year billing experience working denials.
Working knowledge of Medicare and other third-party claims processing, ICD-10 and HCPCS/CPT coding, and medical terminology highly desirable.
Visual acuity and hand-finger dexterity for extended computer work.
Ability to sit at computer workstation for prolonged periods.
Sound reasoning ability and independent judgment.
Capacity to work within specified deadlines.
Excellent communication and interpersonal skills.
Ability to remain calm in stressful situations.
Adherence to safety, ergonomic and health policies.
Compliance with PPE requirements in lab or biohazard areas.
Completion of required safety training and health evaluations promptly.
Proactive approach to identifying and addressing safety hazards, promoting safety awareness.

Nice To Haves

Working knowledge of Medicare and other third-party claims processing, ICD-10 and HCPCS/CPT coding, and medical terminology highly desirable.

Responsibilities

Maintain organized workflow for efficient account processing and seamless task handover during absences.
Adhere to departmental processes, consulting supervisors when needed.
Demonstrate strong customer service skills to enhance department and organizational reputation.
Foster teamwork and meet or exceed work standards.
Possess working knowledge of compliance regulations and apply them effectively.
Follow company policies and maintain accurate statistical data.
Accurately perform order entry and resolve missing information.
Utilize translation tools for entering codes into billing systems.
Communicate effectively with internal and external stakeholders.
Apply payment details accurately and handle overpayments or refunds.
Review Explanation of Benefits from various payers.
Investigate un-adjudicated claims and resolve outstanding accounts.
Process Medicare denials and monitor payer rejections.
Handle fast-paced, high call volume environments with strong multitasking skills.
Focus on positive customer impact and utilize effective verbal and written communication.
Research collection accounts and correct system errors.
Perform additional duties and projects as assigned.