? Perform critical and complex billing functions that require analysis, evaluation, and a thorough understanding of the accounts receivable system. Daily tasks include prescription review, pending orders, benefits, and eligibility analysis, updating WIP icons, communicating with clinicians, and reviewing modifiers and patient signatures.
? Obtain authorizations as required by various carriers via telephone, fax, and online systems to ensure efficient patient turnaround time.
? Review charges for accuracy and compliance in secondary system (OPIE) prior to billing (includes referral shells, detailed orders and modifiers) and submit charges via the MiChart interface and ensure charge reconciliation.
? Review and resolve insurance issues to mitigate claim denials.
? Provide support to clinicians in researching and explaining insurance/billing information to patients.
? Provide quality customer service ? directly answer/respond to patient financial insurance questions.
? Provide patient counseling regarding estimated out of pocket financial liability (coinsurance, deductibles, etc.) and coordinate/collect patient payments.
? Collaborate with Revenue Cycle staff to ensure charges are billed correctly and that the correct authorizations are obtained for specific HCPCS codes.
? Complete monthly WIP review meetings with assigned clinicians to ensure all active patients are processed timely to reduce delays.
? Establish and maintain regular communication with patients, physicians, O&P clinicians, and payors to support efficient billing, authorizations, and overall patient care.