Senior Process Executive
CurrentMedical Biller Representative- Obtain referrals and pre-authorizations as required for procedures.- Check eligibility and benefit verification.- Review patient bills for accuracy and completeness and obtain any missing information.- Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.- Knowledge of insurance guidelines, including HMO/PPO, Medicare, and state Medicaid. - Follow up on unpaid claims within standard billing cycle timeframe.- Check each insurance payment for accuracy and compliance with contract discount.- Updates cash spreadsheet, runs collection reports.Utilization review associate- Analyze information gathered by investigation, and report findings and recommendations.- Modify patient treatment plans as indicated by patients' responses or case history.- Audit and analyze patient records to ensure quality patient care and appropriateness of services.- Interview or correspond with physicians to correct errors or omissions and to investigate questionable claims.Medical Review Summarization- Review or audit medical records for completeness and accuracy by looking at various pieces of documentation.- Incorrect or missing documentation can result in loss of hospital accreditation, a physician's license, or Medicare status. Too many mistakes in documentation can result in a facility closing.- Coordinate in-service meetings to educate the medical staff on proper documenting procedures. Keep abreast of new coding, government, and insurance guidelines.
