JOB DESCRIPTION
Job Title:
Billing Reimbursement Specialist II
Level:
II
Exemption Status:
Non Exempt
Department:
Billing
Reports To:
Billing Reimbursement Supervisor/Manager, Billing Quality & Patient Services
Date Prepared:
Date Revised:
February 18, 2020
Summary:
In this position you will be responsible for reconciliation of medical claims for the purpose of collecting revenue for NeoGenomics. They will work with Third Party insurance bills (HMO, PPO, IPA, TPA Indemnity, Medicare, and Government) responsible for processing independent laboratory claims and Patient Billing.
Responsibilities:
- Focus efforts on increasing cash and reducing bad debt
- Work all incoming correspondence, appeals; review and work accounts to resolution
- Contact Third Party Payers to follow up on claims
- Understands the various NeoGenomics products and tests and can present reasonable arguments for medical necessity on behalf of the patient in order to obtain coverage from the insurance payer
- Appeals and denial management based on payer guidelines in a timely manner
- Knowledge of reading and understanding of EOB’s
- Communicate problems and trends to leads or supervisors in order to escalate large payer or claims issues and follow through on resolution
- Evaluate and respond to all aspects of written billing inquiries from the patient or their representative in order to resolve billing issues
- Review and work various reports including aging
- May have contact with insurance carriers, clients, patients and/or other outside sources
- Ability to understand and interpret advice/remark codes from payers
- Creates clear and detailed notes within the patients account
- Data entry, correct payer assignment to patient accounts, insurance eligibility verification. Review/update demographics and patient information for accuracy.
- Investigate all denied services to determine the reason for the service denial and take the next appropriate action as necessary
- Regular research involving both the internet and billing systems
- Use of various on and off line methods for following up on outstanding claims
- Ensure billing records are maintained in a confidential manner and in compliance with privacy and documentation procedures.
- Meet or exceed daily production standards
- Additional Responsibilities (may be assigned)
Position Objectives:
- Achieves desired level of competency and accuracy for the main department processes within 6 months
- Works productively and efficiently to achieve company and departmental goals
- Communicates effectively with all levels of staff
- Adheres to NeoGenomics Laboratories core values, safety and compliance policies and procedures
- Accurately follows Billing Department SOP’s
Education
HS Diploma
Experience
2 years of experience in A/R, Billing, insurance or healthcare; a background in Laboratory insurance billing preferred
Qualification Requirements:
- Working knowledge of appropriate coding systems; CPT, ICD-10 and HCPCS, coverage; LCD/NCD and Payer Medical Policies associated with such codes.
- Proficient in Microsoft Outlook, Excel, Word, the Inter and Intranet and other programs/software as necessary. Working knowledge and hands-on experience of medical billing and reimbursement.
- Problem solving skills, using good judgment, ATTENTION TO DETAIL AND FOLLOW THROUGH ARE A MUST
- Ability to multi-task and work in a fast paced environment without getting distracted
- Self-starter with the ability to work independently but also able to work on a team and take direction
- Excellent customer service skills; excellent verbal and written communication skills.
- Ability to work overtime as needed, based on department needs
Certificate Compliance Requirements:
Nationally:
FL:
CA:
TN:
Travel Required:
None
Employee Name (Printed): ______________________________________
Employee Signature: ________________________________________________Date: ____________________
