L2 associate_medical billing

Responsible for calling Insurance companies (in the US) on behalf of doctors/physicians and follow up on outstanding Accounts Receivable. Good understanding of Accounts Receivable. Calling Insurance Companies to follow up on Claims filed, to expedite payment. Should possess knowledge in AR analysis, AR calling and denial management. Undertakes denial follow-up and appeals work wherever required. Reviewing, appealing and rejecting unpaid and denied claims. Documents and takes appropriate action of all claims which has been analyzed and followed-up in the clients software. Verifying patients insurance coverage Answering patient billing questions. Should possess knowledge in eligibility and verification calls (EV calls). Experience indirectly working with insurance companies. Analyses outstanding claims and initiates collection efforts as per the aging report.

Should have 1 to 2 years of experience in Payment posting. To understand Medical billing concepts and terminologies to post payments in the billing software. Exposure to Payment posting and denials. Downloading EOBs from the website, Analyzing and posting the Bank statement vs Reconciliation log missing payments. Apply for insurance payments according to specific dates and procedures according to the EOB. Having basic knowledge of insurances to identify Par /Non-Par/ WC / MVA/ etc. Review and assess adjudicated claims for timely and proper payment of outstanding balances. Verify the validity of account balance by researching, reviewing and ensuring accuracy of payment and adjustment posting. Review and interpret Explanation of Benefits (EOB) for denials and underpayment of codes. Responsible for achieving the team s performance standards (KPIs and SLAs).

Audit intermediate and advanced level claim transactions, including reinsurance and high dollar claims. Monitor and report workloads on a daily, weekly, and monthly basis Thoroughly understand the requirements on all work activities and processes being reviewed Meet or exceed audit productivity and quality standards to maintain the integrity of the claim sample. Maintain and report individual and team claim sample and backlogs, ensuring that all claims within sample are audited. Determine error sources and accurate entry of claim audits into the Quality Database daily. Review error trend reports and participate in rebuttal process for continuous improvement; providing feedback to Quality Assurance and Claims teams. Perform focused audits. Attend and actively participate in Quality Assurance Team meetings. Perform other duties as assigned.