About the position
The position involves reviewing and auditing accounts located in the contract management system on a daily basis to resolve and maintain collection status on an account prior to escalating to the Team Lead for further review. The role includes reviewing and processing commercial accounts through the contract/denial management system, verifying eligibility, correcting and resubmitting claims, and filing third-party insurances as necessary by adding or updating insurance information in the host system. The individual will utilize the denial management system and respond to requests from insurance carriers for additional information necessary to process claims. Additionally, the position requires reviewing EOBs in the contract management system to determine accurate account balances, detailed denial descriptions, and applicable appeal processes. The role also involves identifying and correcting transactions, such as invalid insurance information, incorrect charges, and posting errors in the host system, as well as resolving claims processing disputes related to denials and correspondence received.
Responsibilities
- Review and audit accounts in the contract management system daily.
- Resolve and maintain collection status on accounts before escalating to Team Lead.
- Process commercial accounts through the contract/denial management system.
- Verify eligibility and correct and resubmit claims.
- File third-party insurances by updating insurance information in the host system.
- Utilize denial management system to respond to insurance carrier requests.
- Review EOBs to determine account balances and denial descriptions.
- Identify and correct transactions in the host system.
- Resolve claims processing disputes related to denials and correspondence.
Requirements
- High school diploma or GED.
- 6 months to 1 year of experience in hospital or physician office billing and collection processes.
- Experience in producing account appeals with positive outcomes.
- Experience working in an environment that utilizes electronic billing and database management.
- Experience in preparing complex correspondence to resolve accounts.
- General application knowledge of EXCEL and WORD.
