Lead Billing Representative

Hours: 8am- 4:30pm

Hours Per Week: 40 hours

Hiring Range: $20.23-$27.06

The actual compensation for this position will be determined based on experience and other factors permitted by law.

Responsibilities:

· Perform daily file transfers and follow up with the clearinghouse.

· Stay updated on all insurance policies and procedures to guide and educate insurance teams.

· Collaborate with the Senior Claims Analyst to review issues, adjust workflows, and reduce unnecessary workloads.

· Confirm insurance coverage, determine the need for pre-authorization on denied claims.

· Monitor high-dollar denials and rebilling of denied claims.

· Assess financial responsibility for services provided and inform patients and/or practitioners of any non-authorized services.

· Review, monitor and bill Episode of Care claims for our Managed Care plans.

· Maintain monthly KPIs and ROI analysis on hospital claim volume.

· Communicate with patients and practitioners regarding financial responsibility and insurance coverage issues.

· Maintain detailed documentation in patient account records of all billing activities and claims processed as part of the daily claims reconciliation process.

· Prepare and complete claims for commercial insurance companies, third-party organizations, and government or self-payers.

· Research, analyze, and reconcile Medicare/Medicaid billing and reimbursement practices.

· Consult with appropriate parties to resolve unbilled claims and review recent accounts for proper billing practices and reimbursement.

Education:

· High school diploma or GED required. Minimum of three (3) years relevant experience required.

· Certified Revenue Cycle Representative (CRCR) Certification within twelve (12) months of hire required.