Job Information
Keystone Lab Medical Insurance Billing & Reimbursement Analyst I in Asheville, North Carolina
Keystone Laboratory, Inc. - Asheville, NC
An exciting and challenging opportunity awaits a highly qualified Medical Insurance Billing & Reimbursement Analyst I in one of the most beautiful areas in the country, Asheville, NC. (http://www.exploreasheville.com/)
About Wolfe, Inc. / Keystone Laboratory, Inc.
WOLFE, Inc. / Keystone Laboratory, Inc., has been in the business of drug detection and workplace protection for nearly 30 years. We provide a comprehensive array of instant drug testing products and accessories, lab services, background screening, program management and training services for organizations of every size and type. In all we do, our number-one objective is to help all our customers achieve a safe, drug-free workplace—and to do so better and more cost-effectively than anyone else.
Summary/Objective
The Billing and Reimbursement Analyst is responsible for the maximization of reimbursements by contacting insurance carriers and/or 3rd parties daily to collect outstanding insurance balances due, resolve disputes, denials, and general non- payment issues. This position also assists in the management of patient balances, including the negotiation and recovery of outstanding balance.
Essential Functions
Responsibilities include but are not limited to the following:
Have working knowledge of payer determinations, contract fe e s, covered or non-covered items, diagnosis, modifiers, valid HCPC, prescriptions, authorization, eligibility, etc.
Monitor websites for payer policy changes and share information with leadership.
C om p ly w i t h al l appl i cab l e Fede r a l , State, a n d lo ca l la w s, r egulations, and requirements as well as Keystone Laboratory policies and procedures in all aspects of job performance.
Adhere to payer timely filing limits and work accounts to resolve within payer timely filing parameters. Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.
Check eligibility and perform benefit verification, enter charges, and transmit clean claims per coding, carrier, and contract guidelines.
Assist in daily resolution on clearinghouse rejections.
Perform due diligence in reconciling outstanding balances with payers, ensuring all efforts have been exhausted in resolving issues with payers prior to write-off.
Send appeals when appropriate or provide med i cal documentation for m edical necessity within timely filing limits.
Resea r ch a ll pa y er r ef u nd r equests, r eco u pm e n ts, a n d cred i t ba l a n ces for accuracy and appeal if appropriate.
Process a variety of accounts receivable reports, proactively problem-solving claim issues by determining the appropriate follow up action that may include reviewing and writing an appeal for denials and submitting claims, when necessary, after payer contact.
E n su r e t h at g o a l s set f o r c l a i ms, den i a l s, suspe n sions, an d appeals on aged accounts are met within the set deadlines established for department.
Perform analysis of accounts receivable data and understand the reason s for underpayment, days in AR, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments.
C om mu ni cate p ro fess i o n a l l y w i t h ph y si c i a n o ff i c e s a n d a ll o th e r referrals to obtain medical documentation necessary to secure payment.
Maintain accurate and complete records concerning billing and collection activity including documenting the patient's chart and system notes.
Maintain excellent customer service to both our client’s insurance car riers and our provider's patients by performing inbound and outbound calls to assist in any inquiries concerning account activity.
Maintain confidentiality of all patient demographic, medical, and financia l information, ensuring proper handling and disposal of confidential documents and adherence to HIPAA.
Participate in team meetings to share identified non-payment tr ends or other appropriate feedback as it relates to payments and adjustments.
Support department projects and initiatives established for the department.
Rev i e w pat i e n t bi ll s f o r a c cu r acy a n d comp l et e n ess a n d ob ta in any missing information and update as necessary, obtain updated insurance information or any other required information.
Responsible for reviewing patient balances, collecting patient paymen ts, applying to patient accounts, and following up to verify payment was received.
Hel p educate pat i e n ts o n t h eir f in a n c i a l r espo n sib i l i t y f o r b i lled items and any applicable rules and regulations.
Monitor and works Daily Reports to meet department daily contact and collection goals.
Investigate payment status and determines ultimate patient financial responsibility and plans a course of action to collect outstanding balances by offering various financial options that can include patient financial assistance.
Minimize patient distress with active listening, maintaining a professio nal tone, and acknowledging their concerns.
Utilize collection techniques by direct telephone and written corresponde nce to resolve accounts according to the company's policies and procedures.
Must be able to attend work on a regular and predictable basis.
Must be able to work well, efficiently, and with accuracy under the stress of deadlines.
Must be able to complete assigned tasks in a safe manner and in a constant state of alertness .
Basic Skills & Qualifications:
Knowledge of medical insurance payers, billing rules, and regulations through experience in healthcare and/or medical industry.
Knowledge of denials management, AR fundamentals, and experience working with a clearinghouse.
Experience with medical terminology, insurance reimbursement, ICD-10, and CPT coding preferred.
S i gn i f i ca n t exper i ence u s i n g M i cr o s o ft O ff i ce - Wo rd, Exce l , P owerPoint, Outlook, and the ability to learn and adapt to internal software programs.
Strong analytical skills with critical thinking capability to collect, anal yze, and interpret data, resolve complex problems
Must be able to multi-task and prioritize tasks using strong organizational and time management skills.
Must be able to work independently, paying particular focus on detail and adapt to a fast-changing environment.
Must possess excellent interpersonal and customer relationship skills for interacti ng with patients regarding medical claims and payments.
Must possess a positive, open, and friendly attitude with all clients and colleagues.