What are the responsibilities and job description for the Insurance BillingCollector position at United Surgical Partners?
ESSENTIALS DUTIES AND RESPONSIBILITIES :
- Timely follow-up and resolution on all outstanding A / R including unpaid / underpaid / denied claims for all payers including self-pay to obtain maximum reimbursement.
- Manage daily work queue to prioritize high dollar claim balances.
- Review & work incoming insurance and patient correspondence including refund requests.
- Send appeals when appropriate or provide the requested medical documentation.
- Ability to review medical documentation to justify medical necessity.
- Take incoming patient phone calls to resolve inquiries, billing issues, or outstanding balances.
- Review insurance payments and determine accuracy of reimbursement based on contracts, fee schedules or summary plan documents.
- Leverage knowledge of Medicare, state Medicaid, and local coverage determinations (LCD’s) for claim resolution.
- Negotiate payment amounts for procedures with Third Party Administrators for out of network providers.
- Recommend an adjustment when applicable or recommend a refund for overpayments to insurance carriers or patients, providing the appropriate documentation.
Required Skills :
Required Skills
Required Experience
General knowledge of the healthcare industry insurance / EOB payment process
