AllHealth Network
  • Englewood, CO, USA
  • Hourly
  • Full Time

Medical, Dental, Vision, 20 Days of PTO, 7 Company Holidays


AllHealth Network is growing! We are seeking a motivated individual to be a part of our Revenue Accounting team in the FULL-TIME position of Medical Biller to work in our Englewood, CO office. If you are passionate about what you do and want to make a difference, please apply.

Founded in 1955, AllHealth Network provides professional, culturally inclusive mental health and substance abuse services, including outpatient services such as individual, family, marital and group counseling and psychiatry plus a full range of specialized programs including an acute treatment unit, program for those with severe and persistent mental illness, and more.

 

Medical Biller

 

Position Summary:

Responsible for follow-up and resolution with insurance carriers to facilitate appropriate reimbursement. Investigates reasons for out of contract compliance reimbursement and denied claims for appeal to support payment. Documents all activities and contacts in the electronic system. Develops a detailed understanding of assigned managed care contractor and payer requirements. Tracks, reports and communicates payment trends and policy changes.  

 

Qualifications:

  1. Education: High School/GED
  1. Experience: 2 years Medical Billing plus years related physician business office accounts receivable experience
  1. Skills: Computer (Explorer, Excel, Word, Outlook/Groupwise). Knowledge of insurance billing and reimbursement/patient liability, AR and revenue cycle processes. High level problem solving skills, subject matter expert, account analysis and resolution. Ability to multi task and work independently. Good communication skills both verbal and written. Knowledge of professional services office, billing, CPT, ICD10, and Trizetto or other claims clearing houses a plus
  2. Other: Understanding of managed care contracts and insurance compliance

Responsibilities:  

  1. Follow-up on submitted claims:
    1. Review un-adjudicated claims by age and check status with the payer to determine and document the expected payment and timeframe.
    2. Research missing payments or denials and post once located and documented with supervisor.
    3. Verify all registration and billing address data and resubmit claims not on file.
  2. Review denials and proceed with next steps:
    1. Review adjudicated claims with balance pending in insurance responsibility.
    2. Follow-up potential secondary claim status. Bill secondary if necessary.
    3. Contact payer for denial explanation.
    4. Correct claim for resubmission if applicable, electronically.
    5. Create an appeal with documentation if applicable.
    6. Adjust account to guarantor responsibility if applicable.
  3. Appeal tracking, trending and reports:
    1. Document and track open appeals.
    2. Monitor for trends by payer and/or denial.
    3. Research validity of denial as compared to NCCI and payer contracts.
    4. Communicate findings to supervisor.
    5. Attend payer conferences/meetings to resolve payer reimbursement issues.
  4. Adjustment/Transfer to Collections:
    1. Process authorized adjustments following AllHealth Network policies.
    2. Review unapplied cash and work with supervisor to transfer as applicable.
    3. Identify and complete collection workbook with supporting documentation for collections and submit to supervisor.
  5. Documentation:
    1. Document and note all findings and actions taken on an account and/or finance notes according to AllHealth Network policies
  6. AR Age and Projects:
    1. Maintain insurance AR aging to below 150 days.
    2. Work assigned AR and special projects as directed by supervisor.
  7. Accounts Receivable Environment:
    1. Develops detailed understanding of state/federal assistance program, e.g., Medicaid.
    2. Understands federal and state regulations surrounding billing.
    3. Other duties as assigned by management.
    4. Manages own time to be productive.
AllHealth Network
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