Job Description

Physicians Management Group, which provides all administrative services for Maryland Primary Care Physicians LLC, has an A/R Medical Billing Follow-Up Representative opening. Under the supervision of the Follow-Up Supervisor, the A/R Medical Billing Follow-Up Representative will be responsible for having detailed knowledge and experience in following up on insurance claim status, resolving denials and rejections, resubmission of claims, filing appeals, and handling incoming patient calls.

Daily work activities include but are not limited to:

· Responsible for claims denial, verification of insurance, claim status, processing claim appeals, and resubmitting claims as necessary.

· Investigate and resolve outstanding insurance claims within the appropriate time.

• Follow up on denials from insurance carriers and submit appeals when necessary.
• Contact the patient when necessary to obtain correct information for the claim processing.
• Check patient information online via the insurance website or phone call and update information appropriately.
• Answer and respond to patient and insurance carrier calls and address their questions and concerns professionally and on time.
• Document notes accurately and concisely in the medical software system per company guidelines.
• Work with individual practice sites to gather additional information to correct a claim when required.
• Monitor claims submissions, insurance payments, and denials to identify trends and possible issues.
• Review incoming insurance and patient correspondence for appropriate action.
• Respond to e-mail and phone inquiries from individual practice sites.
• Ensure compliance with rules and regulations for insurance carriers.
• Maintain up-to-date information on various insurance companies and any relevant changes.
• Communicate effectively with staff at all levels of the organization, both inter and intra-departmentally.
• Provide guidance and instruction to fellow team members when necessary.
• Provide information regarding work progress, actions, and issues promptly and effectively. Recommend improvements.
• Effectively identify and communicate to the Supervisor changes, issues, or when assistance is needed
• Support and backup other areas of the department as needed.
• Perform other duties as assigned.

TRAINING TO TAKE PLACE ON-SITE.

Knowledge, Skills, and Abilities:

Must have proficient knowledge of insurance requirements, medical terminology, and medical necessity associated with various procedure codes. Proficient knowledge of practice management system/EHR system(s), CPT, modifier, ICD-10 coding, and governmental and commercial insurance guidelines. Have an understanding of insurance explanation of benefits and other insurance correspondence. Experience with Electronic Remittance Advice is preferred. Customer service and phone communication experience with an ability to communicate effectively and provide excellent customer service. Must be able to problem-solve, follow written and oral instructions, and function effectively as a team with other employees. Ability to work independently, both remotely and in an office environment. Excellent time management skills and attention to detail. Maintain patient confidentiality following company policy and procedure and HIPAA regulations. Possess proficient use of computerized billing systems, personal computers, and Microsoft Word and Excel software applications. Epic Software experience is a plus.

Flu and MMR (unless approved for a religious or medical exemption)

PPD

Background Check and Drug Test