Job Functions, Duties, Responsibilities and Position Qualifications:
DENIALS/ACCOUNT RECEIVABLE SPECIALIST
JOB DESCRIPTION
PATHOLOGY LABORATORIES, INC.
Responsible to:
Billing Supervisor
Position Supervised:
None
Qualifications:
High School graduate or equivalent Must have 2-3 years recent billing/healthcare experience in claims follow-up Excellent customer relations skills Work well indendently and be self-motivated Previous medical billing experience Previous account follow up experience Able to handle fast pace environment on a daily basis Ability to analyze, plan work, and prioritize
Relational Skills:
Represent PATHOLOGY LABORATORIES, INC. in a professional manner while effectively and courteously communicating with patients, clients, insurance companies and co-workers. Work in close cooperation with the Billing Supervisor, Client Service, Processing staff and Billing staff. Maintains a professional manner and appearance, remaining calm and objective. Maintain liaison with Billing Supervisor to coordinate in resolving reimbursement or denial problems.
Physical Demands:
Medium work of lifting up to 50 pounds and/or carrying objects weighing up to 25 pounds. Responsible for lifting, carrying, pushing and pulling objects.
Working Conditions:
Sufficient noise and interruptions to cause distraction and stress. Routine duties involve primarily computer entry resulting in repetitive typing and screen viewing. Routine duties involving contacting insurance companies, web-site review regarding claims received, rejected, payment reimbursement, appeals, and other necessary follow up needed on a claim.
Aptitudes:
Intelligence- ability to understand instructions, reason and make judgments. Requirement: High Verbal- Ability to understand meaning of words, ideas associated with them and their effective use. Requirement: High Numerical- Ability to perform arithmetic operations quickly and accurately. Requirement: High Clerical Perception- Ability to perceive pertinent details and verbal or tabular material. Requirement: High Motor Coordination- Ability to coordinate yes and hands to fingers rapidly and accurately in making precise movement with speed. Requirement: High Finger Dexterity- Ability to move fingers easily and skillfully. Requirement: High Manual Dexterity- Ability to move hands easily and skillfully. Requirement: High Color Discrimination- Ability to perceive similarities and differences in color. Requirement: Low
Duties:
Ability to read and comprehend an Explanation of Benefits. (EOB) Properly identify payments or denial errors, ability to determine the need to appeal incorrect denial/payments. Effectively communicate to insurance companies the need for a review of our claim. Knowledge of the HCFA 1500 and to accurately complete when needed. Accurately file and retrieve A/R information. Ability to read, understand and comprehend all billing/financial information in the Misys system, pertaining to patient accounts. Maintain insurance company manual applicable to job function. Knowledge of how to use a CPT and ICD-9 Coding Manual and modifiers. Research and investigate insurance reimbursement issues. Knowledge of secondary claims processing. Treat patients and clients in a friendly manner at all times. Effectively communicate with physician offices and other clients as necessary to complete tasks. Responsible for adhering to work schedule. Perform all other functions or special projects deemed necessary by the Billing Supervisor.
Other Responsibilities:
Adhere to all company policies, including human resource and departmental policies. Attend training such as Annual Safety and Compliance Training, ICD-9 Coding and other training as required by company policy. Participate in annual TB testing, as is company policy and required by OSHA.
Responsible for observing the law, meeting the requirement of the Corporate Compliance Plan and preventing, detecting and reporting unethical or illegal conduct that does not meet compliance standards.
Responsible for maintaining patient confidentiality including tests results, what tests are performed or ordered, the fact that a patient has even has a medical service and billing-related and account issues.
Responsible for complying with HIPAA regulations, as is applicable with our business.
The above list of duties is intended to describe the general nature and level of work performed by the employee assigned to this classification. It is not to be construed as an exhaustive list of duties, nor is it intended to limit the right of any supervisor to assign, direct or control the work of employees under his/her supervison.
Scheduled Weekly Hours:
40
Work Shift:
1st Shift (United States of America)
Company:
Sonic Healthcare USA, Inc
Sonic Healthcare USA provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.
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