Medical Biller/Collector in Laguna Hills, California at Prelude Corporation

This position will perform collections and medical billing for various regional and national payers, including Federal, State, Third Party (HMO, PPO, IPA, TPA Indemnity) and Patient Billing. Qualified candidates must be able to (1) Review accounts for billing accuracy in order to maximize reimbursement. (2) Persuasive and tenacious follow-up on claims status (3) Appeal, and re-bill or forward claims for recalculation and / or adjudication as necessary. Must possess detailed knowledge of all medical benefit levels and have a thorough understanding of Federal, State, PPO, HMO, and Indemnity Plans structure. Must meet or exceed the standard level of performance on assigned accounts.

ESSENTIAL RESPONSIBILITIES:

• Data entry, correct insurance assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy.

• Working knowledge of appropriate coding systems; CPT, ICD-9 and HCPCS, coverage; LCD/NCD and reimbursement associated with such codes.

• Processing, validation of payer requests and processed claims via correspondence, remittance advice and EOBs (i.e., identification of payment discrepancies, inappropriate requests)

• Investigate all denied services to determine the reason for the service denial, appeal, if appropriate. Identify, report root causes associated with denials

• Timely, effective processing of assigned appeals including development, submission, tracking, reporting and evaluation of appeal outcomes (i.e., next steps, improved outcomes)

• Maximize utilization of Billing system, tools, and resources to support cash collection activities.

• Review and work various reports including aging, adjustments and credit balances.

• Comply with Federal and State legislation pertaining to all billing related matters.

• Comply with all Safety, Emergency, Hazard, OSHA, HIPAA, Quality Assurance and Administrative Plans, Policies, Guidelines, Protocol, and Standards.

• Support and maintain department cash and DSO goals

• Other duties as assigned

The above list represents the general duties considered essential functions of the job and is not to be considered an exhaustive description of all the work requirements that may be inherent in the position.

High School Diploma and a minimum of four years related experience or a Bachelor’s degree from a four-year college or university; or equivalent combination of education and experience

• Working knowledge and prior hands-on experience of medical billing and reimbursement. Credentialing experience a plus.

•Proficient in Microsoft Outlook, Excel, Word, the Inter and Intranet and other programs/software as necessary.

• Problem solving skills, using good judgment, attention to detail and follow-through are a must.

• Excellent customer service skills; excellent verbal and written communication skills. Ability to prioritize work, multi-task and time management skills.

• Ability to easily adapt to increased business demands

• Ability to effectively work with and resolve complex accounts & billing issues

• • Establish and maintain cohesive and good working relationships.

• Excellent communication and customer service skills; cooperative, work collaboratively and treat others in respectful, professional and supportive manner.