Worcester MA, MA
- Responsible for follow-up of complex claims for payment.
- Calls insurance companies and utilizes payer web-sites while working detailed reports to secure outstanding payments.
- Reviews rejections in assigned payers and plans to determine validity of rejection and takes appropriate action to resolve the invoice.
- Calculates and posts adjustments based on third party reimbursement guidelines and contracts. Makes appropriate payer and plan changes to secondary insurers or responsible parties.
- Inputs missing data as required and correct i-tag registration and other errors as indicated. Complies with established departmental policies, procedures, and objectives.
- Attends variety of meetings, conferences, seminars as required or directed. Demonstrates use of Quality Improvement in daily operation ns.
- Complies with established departmental policies, procedures, and objectives.
- High School Diploma Three years of physician or medical billing experience Knowledge of regulations multiple major third party insurance carriers
- Knowledge of billing and reimbursement requirements of Third Party Payors in the State of Massachusetts including
- ICD, CPT and HCPCS coding, modifier assignment as well as medical term. Ability to organize and prioritize work to meet strict deadlines.
- Computer skills to include mainframe, PC applications, and excel.
- Must be self-motivated, service oriented and have excellent communication skills (written and oral).
- Unless certification, licensure or registration is required, an equivalent combination of education and experience which provides proficiency in the areas of responsibility listed in this description may be substituted for the above requirements.
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