Job Description
Job Description
1. S/he will be responsible for the submission of all claims to managed care companies and corresponding entities according to established schedules for all programs and services.
2. S/he will review all Explanations of Benefits and Remittance Advices received for payment and resubmit denials of services in a timely manner according to approved procedures.
3. S/he will have knowledge of ANSI837 electronic submission format for HIPPA compliance to ensure successful validation reports.
4. S/he will correct and re-submit claims to commercial insurance, Medicaid and managed care companies according to approved procedures.
5. S/he will validate open Accounts Receivables to ensure that each claim is scheduled for payment according to Connecticut Counseling Centers, Inc. and vendor Policy and Procedures.
6. S/he will review the open claims file and follow-up according to established schedules.
7. S/he will review the Aged Receivable Balance Report according to an established schedule. S/he will suggest write-offs for un-collectable balances with supporting documentation showing that all payment avenues have been exhausted.
8. S/he will be knowledgeable of each payor’s procedures for payment appeals and utilize them for all claims until all avenues for payment have been exhausted or payment has been received.
9. S/he will be responsible for the accuracy of all medical claim forms submitted on CMS and electronically, according to established procedures.
10. S/he will demonstrate professional customer service skills in all internal and external interactions.
11. S/he will maintain an up to date contact list for all payor’s.
12. S/he will ensure that all claims are paid within forty-five (45) days and older claims have been re-submitted to the appropriate appeals committee.
13. S/he will post payments as detailed on Explanation of Benefits into the computer against the patients account according to established procedures.
14. S/he will perform additional duties as assigned.
Company DescriptionConnecticut Counseling Centers, Inc. is a not-for-profit corporation that provides a full range of licensed outpatient substance abuse and mental health prevention, education, and treatment services to assist adults in becoming productive members of society.
Company Description
Connecticut Counseling Centers, Inc. is a not-for-profit corporation that provides a full range of licensed outpatient substance abuse and mental health prevention, education, and treatment services to assist adults in becoming productive members of society.