Billing Associate Ii

3 weeks ago


Los Angeles, United States Pediatric Management Group Llc Full time

Claim Reviews:

- Paper Claims
- Review charge tickets for information and required documents, based on specific divisions and payer requirements, including items such as Insurance verification, Eligibility, Diagnosis code (s), Procedure Code (s) and all other items required by Billing System/Payer.
- Enter charges per division guidelines, utilizing documentation provided, assuring highest level of accuracy, including items entered via SharePoint workflow.
- Maintain billing logs of charges to be used for reconciliation between divisions and revenue cycle.
- Electronic Claims
- Work all billing edits including items such as Insurance verification, Eligibility, Diagnosis code (s), Procedure Code (s) and all other items required by Billing System/Payer.
- Accurately post/void adjustments and patient payments as needed.
- Oversee custom division workflows outside of the standard specialty procedure workflow.
- Request documentation from clinics, patients, and or insurance companies as appropriate.
- Resubmit claims with updated or corrected information per payer guidelines.
- Refer claims to the Revenue Cycle division responsible for updates or correction(s).
- Correctly document the claim notating actions or actions needed to properly submit to the payer.
- Work on complex/escalated claims.
- Oversee all Medical Divisions & assigned Surgical Divisions.
- Escalate problematic claims, with possible recommendations, to the lead or other designated billing personnel.
- Assist with training and mentoring new hires or peers.
- Assist with special projects as needed.
- Maintain an understanding of current billing processing guidelines.
- Consistently meet productivity and quality standards.
- At least three (3) years healthcare revenue cycle experience preferred.
- Ability to communicate effectively in both written and verbal format with internal and external customers.
- Ability to handle multiple tasks simultaneously.
- Familiarity with payer billing and reimbursement guidelines & regulations, including ability to read and interpret payer Explanation of Benefits (EOB), and Remittance Advice Details (RAD).
- Working knowledge of ICD-10.
- Ability to organize and manage time effectively.
- Handle, in a professional and confidential manner, all correspondence, documentation, and files following HIPAA & PHI guidelines.
- Ability to work independently and as a part of a larger team.
- Microsoft-Word, Outlook & Excel knowledge preferred.



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