Job Description
Answer incoming calls from patients, clinician offices, and area sales managers to answer billing-related questions. Educate callers on our reimbursement process, billing policy, and the need for required documentation for appeals and ease any concerns.
Request relevant medical records from clinician offices and ensure appropriate documentation is received and conduct follow-up with the office when applicable.
Review medical records for key details and create custom medical records and appeal cover letters.
Make outbound calls to patients regarding patient consent appeal requirements and effectively communicate the reimbursement process.
Review insurance denials, and insurance company medical policies and submit custom appeal letters.
Review and resolve front-end claim issues for timely and accurate claim submission.
Place outgoing calls or emails to patients, physician offices, and sales for required information.
Review EOBs and electronic remittance advice, and denial letters, assign appropriate ANSI codes, and take the necessary action in the billing system.
Place calls to insurance companies to obtain missing information and/or determine the status of submitted claims as needed.
Utilize payer portals or place follow-up calls to payers for claim status.
Posting insurance, client, and patient payments and taking the necessary action in the billing system
Provide additional documentation to payers when requested to fully adjudicate claims.
Review and submit medical records and appeals to provide proof of medical necessity/criteria to payers.
Investigate, evaluate, and report payer trends to identify opportunities for process improvement.
Responsible for working various billing-related work queues in the billing system.
Identify and report changes to insurance company processing requirements.

Qualification:
At least 2-3 years three years of health insurance billing, medical record review, and appeal submission in the molecular diagnostic laboratory space

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Medix is acting as an Employment Agency in relation to this vacancy.