The Billing Specialist, a key position in the Revenue Cycle, manages the claims process, including accurate and timely claim creation, follow-‐up and correspondence with providers, insurance inquiries/correspondence. The incumbent will assist in the clarification and development of process improvements and inquiries, assure payments related to patient services from all sources are recorded and reconciled timely in order to maximize revenues. Other important duties include credentialing, enrollment processing, and reporting.
• Billing and Claims –
o Prepares and submits clean claims to third party payers electronically.
o Maintains relationship with clearinghouse, including appropriate follow-‐up with support issues.
o Coordinate the process of patient eligibility through various third party sources.
o Handles patient inquiries and answers questions from clerical staff and insurance companies.
o Identifies and resolves patient billing problems.
o Denial and insurance follow-‐up management.
o Issues adjusted, corrected, and/or rebilled claims to third party payers.
o Posts adjustments, transfer of responsibility and refunds, as necessary.
o Assure coding is compliant and up to date.
o Maintains strictest confidentiality; adheres to all HIPAA guidelines/regulations.
• Credentialing –
o Maintain up-‐to-‐date credentials for each licensed provider, including verification through primary and secondary sources, records, and relay credentialing information to relevant personal as needed. Keeps accurate records of provider licensure/ certification renewals
o Advise and apply for new network credentials, and prioritize based on opportunity
o Negotiate on new network contracts
o Get and maintain single case agreements for relevant clients
Salary: ₱15000 - ₱20000
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