Reviews electronic eligibility response files received daily. Updates insurance information on account as needed. Reviews accounts through PCS workfile. Uses appropriate action codes. Meets production standards.

Accesses information through use of billing system and interprets information. Verify if referrals are required. Evaluates patient's full plan benefits with carriers and/or self-pay.

Review and transfer open invoices to ensure all are filed with the appropriate insurance carrier, and that any self-pay is billed. Perform any charge corrections as necessary.

Contacts patient to obtain valid insurance information. If no insurance, advise patients of their financial responsibilities. Requests payment upon resolution of inquiry. Refers complex problems to the appropriate area. Documents patient inquiry and action taken in notes. Make financial decisions concerning delinquent and non-delinquent accounts.

Adheres to guidelines set by the Clinic's Compliance Program, following all Health Care Regulatory Laws on medical coding, billing and reporting of compliance issues. Maintains confidentiality of Clinic materials. Refrains from discussing or releasing confidential information except with individuals legally entitled to such information and as specifically authorized

Skills / Requirements

Excellent organizational and problem-solving skills.

Ability to assess complex situations where multiple options are available and decide upon the best course of action.

Ability to be multi-task oriented, to prioritize and to produce an acceptable volume of work. The ability to conduct thorough interviews concerning financial matters in a relaxed, clear, concise manner.

Possess knowledge of basic telephone etiquette and good public relations skills, to include effective handling of hostile behaviors.

Ability to use PC, including data retrieval and a working knowledge of Excel. Accurate typing of 40 wpm and the ability to compose routine written correspondence.

Ability to operate the following equipment: computer, copier, fax, and 10-key calculator.

Important Notes

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