Additional Info

1. Maintain current and thorough knowledge of the accounts receivable system. (E)
2. Coordinate daily reconciliation of third party payer claims for submission. (E)
3. Resolve claims issues prior to submission. (E)
4. Coordinate timely reimbursement and accurate posting. (E)
5. Research, analyze, and document follow-up and maintain responsibility for maintaining accounts receivable follow-up. (E)
6. Refund or reimburse as needed. (E)
7. Ensure account accuracy and limit denials. (E)
8. Ensure timely billing of the patient, primary, secondary, and tertiary payers. (E)
9. Leverages payer websites and necessary tools to streamline claim follow-up. (E)
10. Process medical documentation/requests, secondary payer information, or any other requests as received to expedite payment and compliance to customer requests. (E)
11. Other duties as assigned (E)

1. Manage review process and appeals for all denials and underpayments.
2. Handles insurance claim denials, underpayments, and re-submission of claims by reviewing reports from claim clearinghouse, explanation of benefits, and remittance advices. (E)
3. Complete initial appeals and second level appeals in a timely manner. (E)
4. Communicate with the payer and resubmit denied or underpaid claims and appeals that have been processed inaccurately. (E)
5. Anticipates potential areas of concern. (E)
6. Monitor payments to ensure appropriate reimbursement. (E)
7. Other duties as assigned. (E)

1. Create claims processing procedure and distribution of duties at MMI. (E)
2. Establish denial and underpayment processing procedures. (E)
3. Establish and maintain a strong working knowledge of laws, regulations, policies, and procedures for billing and collection of multiple specialty areas by participating in continuing education in-services, reading literature, and seeking ongoing development opportunities. (E)
4. Identify monthly trends in repeat denials and recommend process improvements to avoid future denials. (E)
5. Serve as the main compliance liaison for billing practices. (E)
6. Conducts periodic audit review of the billing services. (E)
7. Other duties as assigned. (E)

1. Communicate information regarding billing, payments, denials, and appeals.
2. Assist patients/caregivers in a compassionate and HIPAA compliant manner to evaluate their bills so they have a clear, concise understanding as to their financial responsibility regarding payment of the account. (E)
3. Record all pertinent conversation/actions for an account to provide an accurate documentation of collection efforts. (E)
4. Responds verbally or written in a professional and effective manner to insurance inquiries. (E)
5. Communicates effectively with providers regarding documentation and billing errors and updates. (E)
6. Manages and maintains work queues according to department guidelines. (E)
7. Other duties as assigned. (E)

Determined within a relatively short period of time

Minimal

Customer dissatisfaction, loss of clinical revenue

The position works under general supervision, with assignments based on departmental goals. Employees are expected to manage routine duties and projects independently, with progress reviewed through regular meetings and periodic evaluations.

No

No Supervision:
This role does not have supervisory responsibilities but may work collaboratively with colleagues and offer informal guidance when appropriate.

Office

N/A

N/A

N/A

N/A

N/A