Billing Recertification Specialist

Position Duties:

• Reviews, analyzes, and reconciles initial Accounts Receivable and Order Entry exceptions and discrepancies to ensure accurate invoicing and prompt payment within client business practice and time sensitive guidelines.
• Performs extended resolution activities on more extensive exceptions and discrepancies including engaging parties such as Finance Department, National Contact Center, Contracts Area and client field staff to collect necessary transaction details required to advance the resolution process. Utilizes higher-level knowledge of accounts receivable practices and information systems to identify and remove barriers to account collection.
• Facilitates high volume, extensive professional level verbal and written communications to a broad spectrum of internal and external contacts during all resolution activities operating within strict federal credit guidelines and in full compliance with Sarbanes-Oxley regulatory requirements.
• Researches and verifies all requisite specific transactional information such as contractual stipulations and service dates, initial order entry information, purchase order information, contract information such as price breaks, volume commitment levels, current and actual volume levels.
• Practices continual autonomous decision-making based on knowledge and understanding of a variety of contractual pricing structures. Facilitates independent actions to assure purchasing and activities are within stated contractual guidelines including recognizing and complying with various dynamic and goodwill pricing structures.

Skills:

medical collections, communication and analytical skills, customer service skills, medical record, medical terminology, customer service, call center, health care, medical billing, benefit verification

Additional Skills & Qualifications:

Basic Qualifications:

• High School Diploma

• Ability to maintain confidentiality and discretion in business relationships and exercise sound business judgment.

· Minimum 3years in medical billing office, processing/collecting authorizations to bill medical insurance companies

· Managed care insurance knowledge

· Familiar with billing codes

· Able to read clinical/chart notes to determine a dx code

· Must be familiar with medical records/medical documentation

· Familiar with benefits eligibility and explanation of benefits (EBO)

Experience Level:

Entry Level