Accounts Receivable and Medical Billing Expert II

2 weeks ago

WinstonSalem, North Carolina, United States PriMed Processing, LLC Full time
Position Overview

About Us:
PriMed Processing LLC is a dedicated medical reimbursement firm that specializes in addressing the unique requirements of neurology practices and neurodiagnostic testing facilities. Established in 2001 as a woman-owned enterprise, we have cultivated a distinctive, boutique-style approach to medical billing, achieving exceptional collection rates exceeding 95%. Our mission is to partner with healthcare providers, safeguarding their financial well-being so they can concentrate on delivering optimal patient care. Our remarkable team, with an average tenure of over 7 years, acts as advocates and intermediaries among providers, patients, and insurance companies.

Your Role:
This position is ideal for individuals who thrive on variety and take proactive measures to resolve claims issues. If you have a keen eye for detail, enjoy delving into documentation, and possess a passion for problem-solving, this role is for you. You should have a strong sense of accountability towards insurance carriers and appreciate the importance of clear communication. Above all, you should genuinely care for both patients and providers, relishing the opportunity to advocate for proper compensation for necessary care. At PriMed, we value individuals who take pride in their work, viewing it as meaningful rather than just a job.

Key Responsibilities:

  • Leverage industry expertise to address both new and aged accounts receivable across various account types, including high-value accounts, government claims, denial claims, and professional claims.
  • Identify trends in denials, their root causes, and their impact on accounts receivable.
  • Resolve complex accounts and discrepancies in payments.
  • Draft appeal letters for denials by utilizing specific payer appeal forms, submitting necessary medical documentation, and tracking the resolution of appeals.
  • Follow up on outstanding accounts receivable balances.
  • Verify the accuracy of recoupment requests and dispute them when necessary.
  • Research various Local Coverage Determinations (LCDs) and medical policies relevant to assigned specialties.
  • Address billing inquiries from insurance companies, clients, and patients.
  • Establish patient payment plans.
  • Maintain a comprehensive understanding of medical billing guidelines and procedures, including knowledge of CPT, HCPCS, and ICD10 codes, as well as collections and appeals.
  • Respond to medical records requests from insurance companies to facilitate payment.
  • Review and analyze documentation to ensure accurate coding.
  • Collaborate with healthcare providers to clarify documentation and gather additional information for coding purposes.

Qualifications:

  • High school diploma or equivalent.
  • A minimum of 5 years of experience in the medical billing sector.
  • Solid understanding of health insurance networks, with the ability to distinguish between in-network and out-of-network benefits.
  • Thorough knowledge of medical billing guidelines and procedures, including CPT, HCPCS, and ICD10 codes, as well as collections and appeals.
  • Strong organizational skills and meticulous attention to detail.
  • Ability to engage in deep problem-solving.
  • Capacity to thrive in a dynamic work environment.
  • Ability to maintain focus while multitasking.
  • Capability to work independently, taking ownership of responsibilities without constant supervision.
  • Ability to collaborate effectively as part of a team, working cooperatively with management, colleagues, clients, and carriers.
  • Excellent written and verbal communication skills, enabling effective interaction with clients, patients, and payers in a professional and courteous manner.
  • Self-awareness to maintain composure while demonstrating empathy and courtesy to every caller, regardless of their frustration level.

What We Provide:

  • A family-oriented atmosphere.
  • An independent yet collaborative work environment.
  • A casual dress code.
  • A flexible schedule.
  • A hybrid work model (remote work available).
  • Shortened hours on Fridays.
  • Accrued Paid Time Off for both sick and vacation time, along with standard benefits such as:
  • Health insurance.
  • Life insurance.
  • 7 paid holidays.
  • 401K with up to 4% matching.
  • A variety of optional benefits, including short-term disability, vision, and dental coverage.

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