ESSENTIAL JOB DUTIES & RESPONSIBILITIES
1. Practice Management & Systems Operations
Demonstrates proficient utilization of billing systems (e.g., Epic EHR) to update patient demographic and facility file information, manage pre-AR and post-AR charge sessions, and resolve billing workqueues. Appropriately edits claims and documents account actions using standard claim notes and system workflows. Utilizes clearinghouse portals, banking solutions, and ERA/EOB electronic tools to facilitate account resolution.
2. Claims Submission & Payer Follow-Up
Demonstrates a solid understanding of the end-to-end revenue cycle. Prepares, audits, and submits clean primary and secondary claims electronically or on paper according to payer specifications. Performs diligent third-party insurance follow-up on outstanding claims, resolving complex reimbursement barriers that adversely affect timely payment.
3. Denial & Rejection Management
Analyzes insurance rejections and remittance denials to execute denial workflows. Performs root-cause analysis on recurring denial patterns and collaborates with cross-functional teams to resolve system, credentialing, or payer issues. Maintains accurate tracking, filing, and account documentation for all collections and follow-up activities.
4. Patient Services & Customer Care
Responds to patient and customer billing inquiries professionally and promptly via phone, written correspondence, or virtual communication tools. Facilitates resolution of financial balances, sets up approved payment arrangements, and explains financial assistance policies while strictly maintaining HIPAA and protected health information (PHI) privacy standards.
5. Business Conduct & Workplace Efficiency
Demonstrates proficiency with Microsoft Office applications (Word, Excel, Outlook) and core communication platforms. Displays professionalism, adaptability, and a collaborative team attitude. Maintains high dependability, adherence to schedules, and consistent productivity in a deadline-driven, results-oriented environment.