Experience Inc. Jobs

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