Reimbursement Specialist - Medical Records ID-8324
Job Description
- Answer incoming calls from patients, clinician offices, and area sales managers to answer billing-related questions. Educate callers on our reimbursement process, billing policy, and the need for required documentation for appeals and ease any concerns.
- Request relevant medical records from clinician offices and ensure appropriate documentation is received and conduct follow-up with the office when applicable.
- Review medical records for key details and create custom medical records and appeal cover letters.
- Make outbound calls to patients regarding patient consent appeal requirements and effectively communicate the reimbursement process.
- Review insurance denials, and insurance company medical policies and submit custom appeal letters.
- Review and resolve front-end claim issues for timely and accurate claim submission.
- Place outgoing calls or emails to patients, physician offices, and sales for required information.
- Review EOBs and electronic remittance advice, and denial letters, assign appropriate ANSI codes, and take the necessary action in the billing system.
- Place calls to insurance companies to obtain missing information and/or determine the status of submitted claims as needed.
- Utilize payer portals or place follow-up calls to payers for claim status.
- Posting insurance, client, and patient payments and taking the necessary action in the billing system
- Provide additional documentation to payers when requested to fully adjudicate claims.
- Review and submit medical records and appeals to provide proof of medical necessity/criteria to payers.
- Investigate, evaluate, and report payer trends to identify opportunities for process improvement.
- Responsible for working various billing-related work queues in the billing system.
- Identify and report changes to insurance company processing requirements.
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Qualification:
- At least 2-3 years three years of health insurance billing, medical record review, and appeal submission in the molecular diagnostic laboratory space