Medical Biller Representative (FT)
Full Time
New York, NY
$40,000 - $80,000 a year
Posted
Job description
Job Summary – Medical Billing Specialist, and medical coder is responsible for verifying insurance policy benefit information, and securing payer required referrals and authorizations. This position is responsible for obtaining accurate and timely pre-authorizations for professional services prior to the patient’s visit, following up with insurance payments and sending statements. Obtaining patients incoming calls in regards to questions on statements obtained, and collect payments.
Job Responsibilities:
- Verifies insurance coverage via system tools, payer portals (Electronic Query (Real-Time-Eligibility [RTE]/Insurance Payer Portal/Phone).
- Upon verification of patient's insurance coverage, update changes in the billing system.
- Confirms provider’s participation status with patient’s insurance plan/network.
- Determines payer referral and authorization requirements for professional services.
- Contacts patient and PCP to secure payer required referral for planned services.
- Documents referral in practice management system.
- Research system notes to obtain missing or corrected insurance or demographic information.
- Reviews clinical documentation to ensure criteria for procedure meets insurance requirements.
- Initiates authorization and submits clinical documentation as requested by insurance companies.
- Follows through on pre-certifications until final approval is obtained.
- Manage faxes, emails, and phone calls in a timely manner. Responds to voicemails and emails within same business day of receipt.
- Communicates with provider and medical coordinator regarding authorizations status or denials.
- Submits appeals in the event of denial of prior authorizations or denial of payment following procedures.
- Set up peer to peer calls with clinical providers and insurance companies, as needed.
- Calculate and document patient out of pocket estimates and provide to patient.
- Responsible for being a specialist in the area of payer policy authorizations for internal and external customer inquiries.
- Meet daily/weekly/monthly/annual departmental productivity goals and targets are required.
- Conforms to all applicable HIPAA, Billing Compliance and safety policies and guidelines.
- Serves as primary liaison between faculty practice/department, insurance companies and patient to verify eligibility and coordination of benefits and resolve any insurance complications.
- Performs other job duties as assigned, including but not limited to, job functions in the area of insurance verification unit.
Minimum Requirements :
- High School Graduate or GED Certificate.
- Certified Medical Billing Professional (CMBP, CPC)
- Good interpersonal, verbal, telephone and written communication skills in the English language.
- Functional knowledge of basic computer operation and keyboard functions.
- Ability to follow-through and handle multiple tasks simultaneously.
- Ability to work independently and be team player.
- Must be a positive individual with a positive attitude and exceptional work ethic.
Preferred:
- Minimum of 1-2 years of healthcare customer service experience
- Cardiology coding expert
- Advanced MD
- Knowledge if Medical Terminology, Diagnosis and Procedure coding.
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