All Care To You

Medical Billing and Coding

• Conducts timely and accurate follow-up on professional services claims to ensure all requested information has been submitted and claims are being processed utilizing payor portals, secure chat, secure messaging, and telephone calls
• Identifies missing payments from the health plan and initiates tracking procedures
• Reviews incoming correspondence from health plans and takes appropriate action or escalates to designated team members as needed
• Identifies pending claims and determines next steps required to obtain reimbursement for claim
• Uses existing queries to review limited new denials for processing errors, appropriately assigns a status based on review, corrects any internal errors and resubmits claims as necessary
• Follows up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution
• Monitors incoming messages from providers and responds to the provider or escalates the request to the appropriate team member
• Identifies claims with more complex issues and escalate them to the appropriate team member for resolution as needed
• Research health plan reimbursement policies and procedures, clinical guidelines, coding, and CCI edits to ensure claims are billed appropriately
• Communicate effectively with insurance companies, healthcare providers, and their billing staff to resolve claims issues and answer inquiries
• Document all interactions and updates in the claims management system
• Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures
• Prepare and submit reports on claim follow-up activities and status updates to management as requested
• Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements
• Stay updated on changes in insurance policies, regulations, and industry standards
• Must meet quantitative production standard of working 100 – 150 claims per week
• Attend departmental and company meetings as required
• Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues
• Investigate and resolve discrepancies or issues related to claims processing and payment
• Work with other team members and departments ensure proper claim submission
• Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process
• Participate in training and development opportunities to stay current with best practices and industry trends

Medical Billing Coordinator

• Mentor other team members in the details of their assigned health plan, providing answers to questions and direction when needed
• Review provider escalations and provider resolution or escalation to management as needed
• Review complex patient accounts requiring identification of duplicate claims, corrected claims, overpayments, underpayments, and other issues and work them to resolution
• Conduct timely and accurate follow-up on professional services claims to ensure all requested information has been submitted and claims are being processed utilizing payor portals, secure chat, secure messaging, and telephone calls
• Identify missing payments from the health plan and assists in researching/locating payments
• Review incoming correspondence from health plans and takes appropriate action or escalates to designated team members as needed
• Identify pending claims and determines next steps required to obtain reimbursement for claim
• Use existing queries to review limited new denials for processing errors, appropriately assigns a status based on review, corrects any internal errors and resubmits claims as necessary
• Follow up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution
• Monitor incoming messages from providers and respond to the provider or escalates the request to the appropriate team member
• Assist with special claims research projects as assigned
• Document all interactions and updates in the claims management system
• Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures
• Prepare and submit reports on claim follow-up activities and status updates to management as requested
• Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements
• Stay updated on changes in insurance policies, regulations, and industry standards
• Must meet quantitative production standard of working 75 - 125 claims per week
• Attend departmental and company meetings as required
• Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues
• Investigate and resolve discrepancies or issues related to claims processing and payment
• Work with other team members and departments ensure proper claim submission
• Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process
• Participate in training and development opportunities to stay current with best practices and industry trends.

Medical Billing Coordinator

Medical Billing Team Lead