Billing Coordinator I

About Us

All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients.  ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees.  We also offer paid holiday, sick time, and vacation time as well as a 410k plan.  Additional employee paid coverage options available.

Job purpose

The Billing Coordinator is responsible for managing outstanding claims to ensure timely and accurate reimbursement. This role involves reviewing denied, pending, and unpaid claims, communicating with insurance carriers, and working closely with internal teams to resolve any issues and facilitate the claims process. The ideal candidate must also be able to demonstrate excellent written and verbal communication skills, as communicating with clients and various insurance agents.

Duties and responsibilities

• Claims Management:
  • Conduct timely and accurate follow up on unpaid insurance claims using insurance portals, secure email, secure chat, and phone calls
  • Identify pended claims and determine next steps required to obtain reimbursement for claim.
  • Use existing queries to review limited new denials for processing errors, appropriately assign a status based on review, correct any internal errors and resubmit claims as necessary.
  • Follow up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution.
  • Monitor incoming messages from providers and respond to the provider or escalate the request to the appropriate team member.
  • Identify claims with more complex issues and escalate them to the appropriate team member for resolution.
  • All other duties as assigned.
• Communication:
  • Communicate effectively with insurance companies, healthcare providers, and their billing staff to resolve claims issues and answer inquiries.
  • Document all interactions and updates in the claims management system.
• Documentation and Reporting:
  • Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures.
  • Prepare and submit reports on claim follow-up activities and status updates to management as requested.
• Compliance:
  • Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements.
  • Stay updated on changes in insurance policies, regulations, and industry standards.
  • Must meet quantitative production standard of working 100 – 150 claims per week.
  • Attend departmental and company meetings as required.
• Problem Resolution:
  • Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues.
  • Investigate and resolve discrepancies or issues related to claims processing and payment.
  • Work with other team members and departments ensure proper claim submission.
• Continuous Improvement:
  • Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process.
  • Participate in training and development opportunities to stay current with best practices and industry trends.

Qualifications

• A minimum of 2 years' experience as a medical biller or similar role.
• Solid understanding of billing software and electronic medical records.
• Thorough knowledge of healthcare benefits, coordination of benefits, referral and authorization requirements, and insurance follow up.
• Experience with CPT Codes, ICD-10 Codes, Modifiers, and CCI edits.
• EZ-Cap experience preferred.
• Epic experience preferred.
• Electronic Data Interchange (EDI) Clearinghouse experience preferred.
• Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe.
• Detail oriented and highly organized.
• Strong ability to multi-task, project management, and work in a fast-paced environment.
• Strong ability in problem-solving.
• Ability to self-manage, strong time management skills.
• Ability to work in an extremely confidential environment.
• Strong written and verbal communication skills.