Senior Account Manager - Medical Billing

Job Title: Senior Account Manager – Medical Billing

Department: Billing Finance

Immediate Supervisor Title: COO

Job Supervisory Responsibilities: None

General Summary: An account management position responsible for performing billings for all Insurance Carriers and/or patients.

Essential Job Responsibilities:

1. Reviews and corrects all claims before claim transmission and after. Oversees claims processing/payments to third party providers. Answers associated correspondence.
2. Prints Hard Copy claims.
3. Attaches and prints required documentation to claims for payments and expedites to the claims department for mailing.
4. Corresponds with patients’ billing inquiries.
5. Collaborates with physicians and office managers.
6. Oversight and hands on approach over all daily coding and billing activities and assures practice is in compliance with current standards.
7. Works all denials received from insurance carriers per client assigned. Identifies and corrects exceptional claims for review (EDI pre and post payment edits). Refile as necessary after correction to claim and demographics if necessary.
8. Research corresponds with insurance carriers on all outstanding claims with no response or payments.
9. Documents all correspondence with clients, patients, insurance carriers, and vendors.
10. Maintains required records, reports, files, etc...
11. Corresponds with clients on education materials regarding documentation, CPT codes, ICD10 codes and carrier guidelines relating to assigned client practice.
12. Corresponds with clients and team on all missing billing charges.
13. Responsible for processing refunds for insurances and patients
14. Correspond and educate with data entry staff and demographic staff when necessary for errors, omissions, insurance carrier guidelines.
15. Monitors charges and verifies correct payment of claims and capitation deductions. Audit and review claim payments for accuracy and compliance.
16. Sends denial Appeal letters on claims and follow-up on requests for information.
17. Other responsibilities as assigned.

Education: High school diploma or equivalent. Some college preferred Medical Billing School or practical experience in a billing company or physician /hospital office.

Experience: Minimum five years’ medical billing experience.

Other Requirements: Outlook, Teams, Excel, and Adobe.

Performance Requirements:

 Knowledge:

1. Knowledge of medical terminology.
2. Knowledge of clinic policies and procedures by client.
3. Knowledge of computer systems, programs, and spreadsheet applications.
4. Knowledge of CPT, HCPCS guidelines per carrier.
5. Knowledge of ICD-10.
6. Knowledge of modifiers and appropriate use.
7. Knowledge of HIPPA and PHI policies and practices.

Skills:

1. Skill in oral and written communication.
2. Proficient in current computer programs and applications
3. Skill in time management and organization.
4. Skill in problem solving.
5. Skill in troubleshooting claim insurance problems.

Abilities:

1. Ability to maintain confidentiality of all business/work information.
2. Ability to complete documents with accuracy and completeness.
3. Ability to communicate effectively with clients work with other employees.
4. Ability to collaborate effectively with physicians, other medical staff, and external agencies.
5. Ability to identify and analyze claim problems.

Equipment Operated: Standard office equipment including computers, fax machines, copiers, printers, telephones, etc.

Work Environment: Position is in a well-lighted office environment. Occasional evening and weekend work and overtime as required.

Mental/Physical Requirements: Involves sitting approximately 90 percent of the day, walking, or standing associated with a normal office environment. Manual dexterity using a calculator.