Confirming the patient's insurance plan and eligibility information with third party payer to determine the patient's financial responsibility for services rendered.
Contacting third party payers to obtain approval before services are provided, ensuring appropriate reimbursement.
Entering charges for services and procedures in the billing system, entering adjustments to patient accounts for payments received, generating balance receipts, reconciling daily work batches, preparing an audit trail, and preparing bank deposits.
Completing, submitting, and processing CMS-1500 claims for payments; and researching and resolving claims payment delay issues
Reviewing explanation of benefits and remittance advice documents, contacting payers to resolve claims denials, resubmitting CMS-1500 claims, responding to payer and patient correspondence, following up on assigned accounts, and using collection techniques to maintain current accounts, including monitoring for delinquent payments
Obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization. Credentials are documented evidence of licensure, education, training, experience, or other qualifica
Translating important medical information into simple codes for the purpose of documenting medical records and informing accurate medical billing.