Responsible for claim submission and claim resolution for CCS Medical patients in regards to governmental, commercial insurance companies and patient accounts.
Works individual portfolio of accounts from CCS Medical billing/collection system
Assesses insurance reimbursement for individual supplies to ensure maximum reimbursement
Verifies that all appropriate supporting documentation are obtained prior to shipment and/or prior to billing
Audits configuration of supplies based on supporting documentation, formulary requirements and manufacturer compatibility
Posting payments and / or adjustments to individual accounts
Resolving credit balance accounts as needed
Identifies problems or improvements within own area, develops resourceful and alternative solutions for work improvement or problem solution
Researches and follow up on all correspondence associated with assigned accounts, including EOB’s and documentation letters, and generate correspondence requesting required information, when necessary
Initiates appeals and ensure all required documentation is submitted in the appeals process. Research all denials and follow up as necessary
Receives inbound and places outbound calls to/from insurance companies and patients to collect outstanding funds·
Reduces delinquent accounts and achieving maximum collections from all sources
Produces reports identifying trends or problem carriers, and identify areas of concern and present ideas to correct or prevent future issues
Analyzes and correct accounts receivable problems
Documents all activities as completely as possible.
Achieves productivity goals based on accounts touched, dollars collected, and aging period
Reports any problems to the attention of the Management
Must maintain a high degree of confidentiality at all times due to access to sensitive information
High school diploma or GED equivalent.
Minimum of two years of medical billing/collections experience necessary. Must be knowledgeable of reimbursement processes and procedures.
Ability to work with other employees and provide assistance as needed.
Proficient in basic PC skills. (MS Office).
Organized work habits, accuracy, and proven attention to detail, with strong analytical skills.
Ability to work within a team setting and as an individual contributor.
Excellent oral and written communication skills.
Self-directed with the ability to work with little or no supervision.
Flexible and cooperative in fulfilling all obligations
Ability to interpret rules and regulations set by Medicare, Medicaid, and Commercial payors.
Ability, flexibility, and willingness to learn and grow as the company expands and changes.
Ability to recommend and implement changes to processes for efficiency.
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals; ability to write routine reports and correspondence; ability to speak effectively before groups of customers or employees of the organization.