Correct denied claims by updating correct CPT code, DX code, or add modifier when applicable and resubmit claim for payment• Work all denials accordingly and in a timely manner by correcting the issue that caused denial which may be due to incorrect insurance billed, modifier issues, hospice denials, and medical record request.• Adjust accounts that may deny due to past timely filing, authorizations and referrals if applicable.• Follow-Up on appealed claims and submitted claims that are pending payment• Upkeep the allowable sheet and update due to insurance allowable changes for sleep study, durable equipment supplies and office visit.• Able to communicate and or negotiate problematic accounts• Invoice outside parties regarding incoming requests• Collects and manages patient payment plans and accounts• Use critical thinking skills, organize and respond to urgent or emergent situations• Decision in making skills based on accurate information and/or analysis of data• Strong Communication skills• Knowledgeable in all medical Commercial and Government insurance plans• Ability to remain calm and professional in stressful situations• Understand payer EOBs and identify posting errors of payment and adjustment• Performs appropriate follow-up with payor for payment as appropriate• Payment Posting and Matching• Resolve all payments with missing Explanation of Benefits (EOB)• Close and update daily payment batches• Identify accounts that require refunds• Ensure line items adjustments are performed at time of payment• Familiar with HIPAA and PHI guidelines • 835 electronic payment matching• Research for possible posting errors.

Responsible for working with on-site collection agencies to assure patient accounts are corrected as needed for billing purposes. Receive email information from agency to update or correct patient insurance information and re-bill charges. Review patient accounts for possible charity adjustment. Receive agency payment invoices on a monthly basis which are reviewed to assure patient and insurance payment applied to account correctly. Review agency acknowledgement report which list accounts that are 121 days old to assure that vendor is working account accordingly and to assure accounts need to be moved to secondary vendor for insurance follow-up. Adjust accounts accordingly due to past timely filing, patient discount, or claim denial.

Responsibilities included registering patients for all modalities in the outpatient imaging center and handling the collection of co-pays, deductibles, and making appropriate payment arrangements. In addition, accountable for verifying medical benefits and pre-certifying patient’s exams within 24 hours of scheduled appointment, and calculating amount due by patient. Assured Medicare, Medicaid, and Managed care guidelines are met and informing patients of any issue before appointment. Assure all diagnosis codes are listed on order for all scheduled appointments. Fax and documentation as needed to doctor office or pre-certification departments.