Medical Insurance Billing & Reimbursement Analyst I

Keystone Lab Houston • Asheville, NC

414d

About The Position

The Medical Insurance Billing & Reimbursement Analyst I is responsible for maximizing reimbursements by managing insurance claims, resolving disputes, and ensuring compliance with regulations. This role involves daily communication with insurance carriers and patients to collect outstanding balances and manage patient accounts effectively.

Requirements

• Knowledge of medical insurance payers, billing rules, and regulations through experience in healthcare and/or medical industry.
• Knowledge of denials management and AR fundamentals.
• Experience with medical terminology, insurance reimbursement, ICD-10, and CPT coding preferred.
• Significant experience using Microsoft Office - Word, Excel, PowerPoint, Outlook.
• Strong analytical skills with critical thinking capability to collect, analyze and interpret data.
• Ability to multi-task and prioritize tasks using strong organizational and time management skills.
• Ability to work independently with attention to detail in a fast-changing environment.
• Excellent interpersonal and customer relationship skills for interacting with patients.

Nice To Haves

• Experience working with a clearinghouse.

Responsibilities

• Contact insurance carriers and/or 3rd parties daily to collect outstanding insurance balances due.
• Resolve disputes, denials, and general non-payment issues.
• Assist in the management of patient balances, including negotiation and recovery of outstanding balances.
• Monitor websites for payer policy changes and share information with leadership.
• Comply with all applicable laws, regulations, and Keystone Laboratory policies.
• Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
• Check eligibility and perform benefit verification, enter charges & transmit clean claims per coding, carrier, and contract guidelines.
• Assist in daily resolution on clearinghouse rejections.
• Perform due diligence in reconciling outstanding balances with payers.
• Send appeals when appropriate or provide medical documentation for medical necessity.
• Research all payer refund requests, recoupments, and credit balances for accuracy.
• Process accounts receivable reports and problem-solve claim issues.
• Ensure goals for claims, denials, suspensions, and appeals are met within deadlines.
• Analyze accounts receivable data to understand reasons for underpayment and denial.
• Communicate professionally with physician offices and referrals to obtain necessary medical documentation.
• Maintain accurate records concerning billing and collection activity.
• Provide excellent customer service to insurance carriers and patients.
• Maintain confidentiality of patient information in compliance with HIPAA.
• Participate in team meetings to share non-payment trends and feedback.
• Support department projects and initiatives.
• Review patient bills for accuracy and completeness.
• Collect patient payments and follow up to verify payment was received.
• Educate patients on their financial responsibility for billed items.
• Monitor and work Daily Reports to meet collection goals.
• Investigate payment status and determine patient financial responsibility.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Industry: Ambulatory Health Care Services
• Education Level: No Education Listed