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Summary

Major Job Functions

The following is a summary of the major essential functions of this job.  The incumbent may perform other duties, both major and minor, that are not mentioned below.  In addition, specific functions may change from time to time:

• Follow up on outstanding A/R by working and analyzing denials, following up on unpaid claims (primary, secondary or tertiary) with payers and researching issues that have contributed to unpaid claims

• Ensure accurate claim processing by following up with payers as needed using payer websites and phone calls to ensure timely payment

• Work in revenue cycle system to process claims, check eligibility and make corrections to ensure customers and payers receive accurate and timely claim resolution

• Coordinate and communicate with practices/hospital departments as needed to answer claim related questions and process claims accordingly

• Research and make necessary corrections to insurance company requests through timely follow-up and correspondence (i.e medical record requests, appeals, claims resubmissions)

• Complete Payment Tracking Forms when monies have been sent to the hospital

• Complete refund forms for monies due to an insurance company or a patient due to an overpayment

• Keeps management team abreast of challenges with reimbursement or claim related trends

• Other duties as assigned

Minimum Qualifications

The following qualifications, or equivalents, are the minimum requirements necessary to perform the essential functions of this job:

Education and Formal Training: 

• High school graduate or equivalent required

Work Experience: 

• 1-year experience in physician billing, medical practice charge entry or coding and/or hospital revenue cycle process and practices required

Knowledge, Skills, and Abilities Required: 

• Proficiency in reading, writing, and speaking the English language

• Knowledge of medical billing and insurance reimbursement practices and procedures and medical insurance requirements

• Communication skills

• Excellent customer service and teamwork

• Computer skills including Microsoft suite

• Knowledge of medical terminology, ICD-9 and CPT-4 coding

• Ability to type accurately 45 words per minute

Physical Requirements: 

• Motor coordination and finger dexterity required to operate the calculator, computer keyboard and typewriter

• Light lifting and carrying may be required

• Reaching for and handling light weight files

Required Licenses and Certifications

Cape Fear Valley Health System is an Equal Opportunity Employer M/F/Disability/Veteran/Sexual Orientation/Gender Identity