• Verify all scheduled appointments have eligible coverage within 24 to 48 hours prior to appointment.
• Same day review of schedule to identify any add-on appointments and verify eligible coverage for visit. Schedulers should be notifying you for any add on appointments if less than 24 hours.
• Contacting insurance companies via telephone for every procedure or device 24 to 48 hours prior to appointment. Mark appointment with name and reference number. Log more specific, detailed notes in the call log identified with patient name, insurance company and synopsis.
• Communicate any changes in eligibility or coverage to biller; update information in Epic; and indicate on appointment note the requirement to secure a copy of new insurance card and any relevant data.
• Familiarity with Emdeon, Nehen, and all payer sites providing on-line eligibility tools. Verify our data is correct for all patient accounts, including correct data such as demographic, payer or PCP. Make updates as necessary.
• Provide support to office staff/schedulers related to entering data in either system.
• Know the industry standards for medical necessity for payment posting and denial work.
• Accept telephone calls for billing questions and provide answers.
• Accept telephone payments from patients.
• Inform patients when insurance referral and/or prior authorization is needed for treatment.
• Familiarity between referral and prior authorization, and identify when they are required for specific services.
• Understand closed payer types vs. payer types that we do not accept, or only accept under specific circumstances.
• Investigate any and all anomalies that are showing in the systems as they relate to scheduling to help determine root cause.
• Enter new patient data for circumcisions and surgical assists.

This is a very fast paced position, the practice sees about 125 patients per day. This candidate needs to be very well versed in navigating payor sites, work well with others, and have a strong attention to detail.

Must Have Skills/Qualifications:

• 1+ years of experience working in private practice billing**
• EPIC
• Proficient with navigating payors and insurances

Schedule/Shift: M-F between 8am-5pm

For California Applicants:

We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).

This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.