Medical Billing and AR Specialist

Job Description

Primary Responsibilities:

• Responsible for obtaining authorization for pain management procedures from insurance companies.


• Responsible for Billing and Coding, Pre Certification and Credentialing


• Responsible for collecting, outstanding account payments.


• Responsible for following up with insurance companies and patient accounts.


• Has knowledge of commonly-used concepts, practices, and procedures within the Medical Billing and Medical Insurance field


• Complete multiple tasks simultaneously


• Work independently, detail oriented and organized


• Proficient w/ government and commercial Understanding of insurance websites and form fields for authorization submission


• Maintain up to date information on various insurance companies and any relevant changes


• Keeps management informed of changes or issues


• Completes other tasks or responsibilities as assigned


• Responsible to reduce aged A/R.


• Analyze Explanation of Benefits (EOB’s) and Correspondence to identify zero pays and underpayments.


• Responsible to follow-up with healthcare insurance companies on outstanding medical claims and appeals.


• Maintain open communication with the insurance verification team, billing department and office support staff.


• Conduct collection actions and provide resolution for complex accounts.


• Provide supporting documentation that supports collection actions.


• This position is responsible for obtaining and completing all insurance pre-certifications and authorizations as required for various clinical procedures.


• Determines necessity for pre-certification and coordinates with insurance companies, patients and clinical staff to obtain information.


• Maintains complete and accurate documentation in patient charts.


• Develops and maintains effective relations with insurance companies, physicians and medical office staff.


• Must have proficient knowledge of insurance requirements, medical/clinical terminology, medical necessity associated with various clinical procedure codes and certification/referral work flow.


• This position requires the ability to work with minimal supervision.


• Monitor new patient report and maintain organized list with status of pre-certification process.


• Verify insurance eligibility and benefits via phone and/or internet access. Update insurance policy information.


• Check insurance payment policy for scheduled procedures and obtain prior authorization when required.


• Verify receipt of all necessary pre-authorization documents prior to procedure


• Communicate effectively with the facility in which the procedure will be performed as needed.


• Assign appropriate ICD and CPT codes pre-operatively based on documentation and booking slips.


• Notify primary care physician for managed care plans that require PCP authorization.


• Serve as a resource on insurance, billing and customer service for reception.