Process Associate Billing & Rejections - Ambulatory

Process Associate Billing and Rejections will be responsible for accurately verifying and submitting the medical claims, identifying, and resolving claim rejections. This position primarily focuses on claim scrubbing, handling claim edits, billing processes and addressing claim rejections.
Responsibilities

• Review and verify patient demographic and insurance information to ensure accuracy.
• Confirm that all necessary documentation and authorization are in place before submitting claims.
• Review and assess medical claims for accuracy and completeness.
• Identify discrepancies or missing information and rectify them promptly.
• Review and update claim documentation as necessary.
• Submit medical claims to insurance companies following established billing guidelines.
• Utilize billing software and systems to ensure accurate and timely claim submission.
• Monitor and track the status of submitted claims.
• Analyze and address claim rejections promptly.
• Make necessary corrections, resubmit claims, and follow up to resolve outstanding rejections or claim edits.
• Stay up to date with healthcare regulations and insurance policies.
• Ensure billing practices adhere to industry standards and compliance requirements, including HIPAA.
• Ensure insurance coverage and eligibility.
• Review each claim and adjust the incorrect information accordingly.

Qualifications/Requirements

• High School (HSC) or graduate or equivalent with strong analytical skills.
• Proven experience in medical billing and claim rejection management.
• Proficiency in medical billing software and electronic health record (EHR) systems.
• Knowledge of medical terminology, ICD10, CPT, and HCPC coding.
• Detail-oriented with a high level of accuracy.
• Knowledge of healthcare regulations and compliance (HIPAA, CMS guidelines, etc.).
• Problem-solving and critical-thinking abilities.
• Familiarity with insurance processes and payer guidelines.
• Basic working knowledge of computers.

Preferred

• Familiar with healthcare patient billing systems (Practice management) like NextGen, eCW, Experity, AdvanceMD.
• Familiar with clearinghouses like Waystar, Realmed Availity, Change Healthcare, via track.
• Proficiency with MS Excel, MS Word, Outlook, etc.

Other Skills and Abilities

• Ability to work independently with minimal supervision.
• Good analytical skills, assertive in resolving unpaid claims.
• Ability to multi-task and accurately process high volumes of work.
• Strong organizational and time management skills.

Individual Contributor