The Medical Insurance Billing Specialist will work closely with customers and insurance companies to collect payments. Ensure that payments are collected in an accurate and timely manner. Payroll accounting experience needed.
•Work with clinical staff, and stakeholders to identify new overpayment issues for each client. •Participate in the review of health insurance claims and member eligibility information to uncover claims overpayment trends associated with non-compliance or misapplication of contract terms and rates, payment policies, medical policies, billing guidelines, and applicable regulatory requirements. •Develop specifications for IT programming related to overpayment algorithms and analysis. •Review IT programming results for quality assurance and proof of concept validation. •Document results and supports preparation of internal and external documentation and presentations related to research and new overpayment issues. •Work with internal operations and clinical teams to develop and implement review/audit/recovery protocols and internal review guidelines. •Track and follows-up on results and recoveries. •Develops and validates workflows and communication tools to best enhance audit production, client satisfaction, and quality assurance. •Work with IT to develop and implement technological improvements that will support the audit process. •Develop business criteria to maximize the identification of contractual & billing compliance audit recovery opportunities.Requirements: Knowledge of provider billing and patient accounting practices to research of client policy and data to reveal new overpayment recovery opportunities.
• EDUCATION: A.A.
Mortgage Broker, Healthcare - Medical Claims and Billing
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