<h3>Job Description</h3>
Job Description
1. Review and submit clean claim for payment
<ul>
<li>Reviews and corrects all claim edits in the clearinghouse.</li>
<li>Reviews and corrects all edits within the EMR software.</li>
<li>Ensure proper secondary billing.</li>
<li>Review and submit Paper claims with required attachments if appropriate.</li>
<li>Verifies all unknown information with the appropriate department.</li>
</ul>
2. Process Medicare DDE.
<ul>
<li>Review and correct all Medicare claim edits for submission to WPS.</li>
<li>Review and correct all Return to Provider claims.</li>
</ul>
3. Completes Timely Follow-Up.
<ul>
<li>Reviews account balances to ensure accuracy.</li>
<li>Achieves department weekly goal for follow-up.</li>
<li>Works with payers on denials with processes including, but not limited to, phone call verifications, medical records submission, reconsideration and appeals.</li>
<li>Ensures the proper and timely submission of patient responsibility to statement vendor.</li>
</ul>
4. Completes Regular Review of Aging.
<ul>
<li>Reviews aging reports on a regular basis.</li>
<li>Completes frequent follow up on aged accounts.</li>
<li>Reports issues to direct supervisor.</li>
</ul>
5. Performs other duties as assigned.
<ul>
<li>Submission of reconsideration and appeals for payer denials as required.</li>
<li>Completes and passed all training and exams.</li>
</ul>
&nbsp;

Insurance Billing Specialist

Job Description