Overview: this position is responsible for analyzing and resolving professional and facility claims with insurance and patient overpayments timely in epicStrong knowledge of payor requirements in overpayment resolution is required.
Responsibilities/job description:
Monitors accounts for timely follow-up and prompt resolution of overpayments following payor guidelines.
Work as a team player in day to day responsibilities.
Assists in continuously improving outstanding credit a/r while minimizing controllable loss categories (i.eTimely filing).
Ensures incoming overpayment inquiries are processed timely.
Review and process payor correspondence timely.
Ensures that all written responses are clearly and professionally communicated.
Strong knowledge of all major healthcare payors policies/guidelines on overpayment resolution including but not limited to timely filing guidelines.
Working with patient accounts, resolving both insurance and patient credit balance within payor guidelines.
Understanding, verifying insurance coverage, updating insurance coverage and claim submission as needed.
Reviewing payor remits to determine how to appropriately resolve overpayments.
Contacting payors as needed to allow credit resolution including attending payor operation meeting to represent payor/provider ongoing claims/payment processing concerns.
Assisting in overpayment recovery audits.
Meet work quality and productivity expectations.
Seeks process improvement/efficiencies.
Ability to work all payor overpayments to resolution.
Communicate trends and system breaks with examples and possible solutions.
Knowledge of professional and facility billing, claim processing and overpayment resolution.
Qualifications: 3 or more year in an office clerical setting, of which 2 years’ experience in a hospital or clinic business office processing medical claims and overpayment resolution strong knowledge of all major insurance healthcare plans 1 years epic experience fluent in windows applications
