Manager is responsible for managing the Insurance Accounts Receivable Representative's primary responsibility is to provide the highest quality of customer service and accounts receivable management to our patients by embracing the Well Care Guiding Principles. The representative will review and analyze patients medical records in conjunction with the accounts receivables to ensure that the claims were billed correctly, and that the insurance company has the necessary information to adjudicate the claims. The representative must be well versed with the insurances and adjudication processes of their partner practices. The representative will follow the prescribed steps in the Insurance Follow-Up Process to ensure that the outstanding A/R is collected within 120 days from the aging date. The representative will accept other duties/projects as assigned by the Revenue Cycle Manager. Must be knowledgeable of HIPAA Law, and standard coding such as CPT/HCPCS.
Manager is responsible for The Insurance Accounts Receivable Representative's Role and Responsibilities
Prepare and edit medical claims for submission electronically, to various third party payors and clearing houses.
Follow-up and collect outstanding aged trial balance reports, including but limited to oral and written communications. Analyzes and appeals difficult to collect accounts.
Review and process the daily correspondence to correct or update inquiries from insurance carriers.
Manager is responsible for managing the Certified Professional Coder CPC primary role of the Specialist is to abstract and identify the correct CPT and ICD-10 codes from various encounter forms and medical reports and file claims to insurance for timely and accurate reimbursement. The Specialist, Medical Coding and Billing is responsible for assisting other staff with CPT and ICD-10 coding issues hindering expedient collection processes. Responsibilities include confirming modifier coding, utilizing sound professional coding judgment in establishing priority sequencing of diagnosis codes and services to assure maximum allowable reimbursement consistent with Insurance Carriers.
Supervisor is responsible for Medical Coding and Billing Responsibilities:
Assigns appropriate codes for a 95% accuracy rate or better (quality standard).
Reviews chart documentation to support ICD-10 and CPT codes, and takes appropriate
action if documentation is not supported by coding appropriately.
Analyzes and evaluates findings, diagnosis and procedure codes identified by clinicians.
Researches CPT and ICD-10 coding discrepancies for compliance and reimbursement accuracy and timeliness.
Utilizes Internet and other resources to research newly identified diagnosis and/or other procedures.
Answers inquiries from staff and/or clients concerning CPT and ICD-10 codes.
Maintains updated knowledge of coding requirements; including continuing education
and certification renewal.
Maintains accurate and up to date logs of discrepancies in coding trends and root cause analyses that negatively impact collections and presents this information and innovative resolutions to the Senior/Billing Manager.
Manager is responsible for managing Payment Posting Representative- Role To outline the expectations for all WC Health employees or contractors who receive cash payments, check payments, or electronic remittance advice (ERA's) payments that should be posted to the AR, General Ledger, or any other source that may require payment posting receipt(s). All payments received will be assigned a receipt, either in the form of manual entry, or electronic entry. All cash received will be posted to the system for AR billed accounts. A daily reconciliation of bank deposits and cash receipts will be balanced and reported on a daily basis. Remittance error will be reviewed and updated on a daily basis.
Essential Functions:
Apply remittances consisting of deposits, credit cards, and checks in a timely and efficient manner
Perform, research and initiate resolution of unapplied cash items.
Ensures that third party payments posted are in accordance with WC Health payor agreements.
Ensure all batches posted are appropriately scanned into the correct date and verified.
Ensure all batches posted balance to the batch deposit total.
Knowledge, Skills and Abilities:
Knowledgeable ERA (Electronic Remittance Advice), Lock Box and EFT (Electronic Fund Transfer)
Manual Payment Posting Knowledge
EOB Knowledge
Payor Contractual Agreements /Fee Schedule Knowledge
Banking/Deposit Knowledge
Manager is responsible for managing Eligibility and Benefits Representatives Role to verify all scheduled appointment insurance coverage. Variance Medicaid Medicare and commercial insurance 3 days prior to the appointment scheduled date. All new patient appointments need to be verified before being scheduled. Verification includes Provider credentialing with the health plan, eligibility status, effective date, other health insurance or coordination of benefits, patient cost share responsibility ( copay , Co-ins or deductible. Representative will need to review patient ledger for any outstanding balances due from patient and communication with the Insurance denial management team if there's any trends, denials, claims that have not processes. Representative need to verify if authorization or referrals are required for service.
