medical insurance acct receivable & payable rep..

Accounts Receivable Management: Process and reconcile payments received from medical insurance companies, patients, or other third-party payers. Ensure accurate recording of payments and follow up on any outstanding balances or denied claims.Claim Billing and Submission: Generate and submit accurate and timely medical insurance claims to payers for reimbursement. Verify claim information, including patient demographics, diagnosis codes, and procedural codes, to ensure compliance with billing guidelines.Denial Management: Investigate and resolve claim denials or rejections by identifying the root causes, making necessary corrections, and resubmitting claims for reimbursement.Insurance Verification: Verify patient insurance coverage and eligibility prior to providing medical services. Communicate with insurance companies to confirm coverage details, benefits, and authorization requirements.Accounts Payable Processing: Review and process invoices received from vendors, medical suppliers, and service providers. Ensure proper coding, authorization, and accuracy of invoice details before initiating payments.

4-7 years

Expense Reconciliation: Reconcile vendor statements with accounts payable records, resolve any discrepancies, and address outstanding balances or past due invoices.Financial Reporting: Prepare regular reports summarizing accounts receivable and accounts payable activities, aging analysis, cash flow projections, and other financial metrics as required by management.Compliance and Documentation: Ensure compliance with billing regulations, insurance company guidelines, and internal policies. Maintain accurate and organized records of financial transactions, invoices, and payment documentation.Customer Service: Respond to inquiries from patients, insurance companies, and vendors regarding billing, payments, and account-related matters. Provide excellent customer service and address concerns or disputes in a timely and professional manner.Process Improvement: Identify opportunities to streamline and improve accounts receivable and payable processes, including automation, efficiency enhancements, and system upgrades.

Skills and Qualifications:Solid understanding of medical insurance billing and reimbursement processesKnowledge of medical coding systems (e.g., ICD-10, CPT)Familiarity with insurance claim submission requirements and payer guidelinesProficiency in using billing and accounting software systemsAttention to detail and accuracy in financial data entry and record-keepingStrong analytical and problem-solving skillsExcellent organizational and time management abilitiesEffective communication and interpersonal skillsUnderstanding of financial reporting and analysisKnowledge of relevant healthcare laws, regulations, and compliance standardsAbility to work independently and as part of a teamPrior experience in medical insurance accounts receivable and payable is preferred.

High School