Billing Specialist
Oakland Community Health Network
Patient Financial Services Associate II
Exact Sciences
full-time
Posted on:
Origin: • 🇺🇸 United States
Visit company websiteSalary
💰 $37,000 - $63,000 per year
Job Level
JuniorMid-Level
About the role
- Process claims, appeals, denials, and statements accurately and timely for Exact Sciences
- Resolve billing discrepancies, eligibility, denials, appeals, and aged unpaid claim follow up for commercial, government, and plan coverage
- Use Epic, external portals, and other software to communicate insurance information and ensure appropriate coverage
- Review and resolve payor denials, appeals, and claims via portals, calls to payors, and system investigations
- Read and interpret explanations of payments to resolve back end claim resolution
- Determine patient insurance eligibility verification and update Epic (demographics, financial, guarantor information)
- Interact with insurances and third-party payors to obtain and document authorizations
- Research missing or erroneous information using portals and resources, including outreach to identify unknown payors
- Review/edit claims and appeals prior to submitting to clearinghouse
- Analyze, research, and resolve claim issues applying federal, state, and payor rules and procedures
- Correct rejected claims from claim scrubber, clearinghouse, or payor
- Review explanations of payments, identify denial resolution steps, appeal, write-off, or send statements
- Investigate payor underpayments and follow up with payors via phone on unpaid aging claims
- Provide supporting documentation to insurance payor as needed
- Perform write-offs following policies and guidelines
- Participate in team meetings to share denial trends and contribute workflow improvements
- Provide ad-hoc departmental support and special projects
- Complete responsibilities within time frame adhering to quality standards
- Maintain confidentiality and adhere to HIPAA guidelines
- Work Monday through Friday normal business hours and be able to work in front of computer ~90% of day
Requirements
- High School Diploma or General Education Degree (GED)
- 2 years of experience in medical billing, claims, and/or insurance processing
- Extensive and current working knowledge of government, managed care, and commercial insurances claim submission requirements, reimbursement guidelines, and denial reason codes
- Knowledge of medical terminology and/or health insurance terms
- Knowledge of EHR operating systems and work involving electronic records
- Proficient in computer systems and keyboarding skills
- Demonstrated strong attention to detail and focus on quality output
- Demonstrated ability to perform the Essential Duties of the position with or without accommodation
- Authorization to work in the United States without sponsorship
- Preferred: Related Associate degree or medical billing certification
- Preferred: 4+ years of experience in medical or insurance billing field
- Preferred: Experience with Epic or other EHR application
