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Mobile Medical Response Claims/Billing Specialist in Saginaw, Michigan

Description

Essential Duties:

  • Know and support the Mission Statement, Policy/Procedures and standards of MMR.
  • Proficient with billing and prebilling the following insurances: Medicare, Medicaid, BCBS, and Commercial including auto hospice etc.
  • Verify coverage through C-Snap, Web Denis, and Trizetto.
  • Utilize hospital websites to obtain insurance information.
  • Verify coverage and auto insurance for claim/billing information over the phone, as necessary.
  • Obtain authorization number and record the authorization number in the required field, prior to prebilling the claim.
  • Contact patient for insurance information when correct information is not initially provided.
  • Review Physician's Certification Statement (PCS) for proper signature, medical necessity, and completeness.
  • Obtains repetitive Physician Certification Statement (PCS) when needed 14 days prior to the expiration of a current PCS.
  • Proficiently verify all insurances that relate to the claim.
  • Verify and correct patient demographic information.
  • Add CMS signature when obtained.
  • Maintains HIPAA compliance.
  • Pre-bill all emergency and non-emergency claims.
  • Understand proficiently Tier 1/Tier 2, ALS 1 with and w/o ProQA/EMD) ALS 2, SCT/Neonate/Emergency and nonemergency transports and how these assist in determining the charges.
  • Understand proficiently EMT-Basic, EMT-Paramedic, Specialty Care Transport (SCT) trained staff.
  • Places claim in appropriate schedule i.e., Auto 1/Neonate 1/Care/Caid, etc.
  • Maintain HIPAA compliance.
  • Follows up on claims within 30 days after being sent to the payer.

Medicare/Medicaid follow-up:

  • Complete Medicare requests, process follow up rejections/denials and appeals for Medicare and Medicaid claims.
  • Process Medicare and Medicaid refunds.
  • Follow-up on lacking Medicare Signatures via mail/phone calls.
  • Resubmit accounts when new or corrected information is obtained from the caller or payer.

Blue Cross Blue Shield (BCBS) follow-up:

  • Complete BCBS/Patient Care Report (PCR) information requests.
  • Process BCBS rejections/denials.
  • Process BCBS refunds.

Commercial follow-up/Patient Pay

  • Follow-up with commercial payers including auto.
  • Assists Patient Pay follow up as necessary.
  • Process commercial insurance and patient payment refunds.

Perform other duties as assigne

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