Hughston

Analyst

• Organize clinic claims for electronic or hard copy fax/mail and ensure receipt by appropriate third-party payors
• Review claims to ensure payor specific billing requirements are met
• Maintain active follow-up of outstanding accounts receivable
• Determine and apply appropriate adjustments
• Manage assigned accounts receivable as assigned to meet or exceed individual and departmental goals
• Review clinical documentation detail to ensure correct billing of procedures
• Appeal and/or dispute denials and underpayments when appropriate
• Adhere to timely follow up requirements as outlined by payor regulations for claims billing, resubmission and appeal
• Assist patients with questions/payments on their accounts, and update accounts when necessary
• Research and submit refunds for payment to meet regulatory requirements
• Establish/maintain relationships with office and clinical staff
• Obtain hospital authorizations when needed for claim billing
• Assist patients with the arrangement of payment plans for outstanding balances as outlined by clinic policies
• Collect monies owed by patients using third party software in accordance with all applicable third-party vendors, accounting and financial policies
• Ensure internal policies and procedures are adhered to by third-party outsourced vendors
• Process and post payments taken over the phone or virtually
• Maintain Unpostable Dashboard
• Educate assigned front desk staff regarding billing issues when identified
• Use of procedure ICD 10, CPT and Modifiers to meet compliance requirements and clean claim rates
• Navigation and use of payor sites functionality
• Determine eligibility/co-insurance/copayments and deductibles
• Complete HCFA 1500 as required by insurance payor policy requirement
• Complete accounts receivable follow-up exception reports

Reimbursement Analyst