Zero Balance Auditor
New
United States - Remote; Franklin, TNFull-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 5+ years’ experience in healthcare field working in billing or collections
- Required Skills
- Microsoft Office
Requirements
- High School Diploma or GED required; Associates or Bachelor’s Degree preferred.
- 5+ years’ experience in healthcare field working in billing or collections.
- 1+ years’ client facing/customer services experience.
- Intermediate level understanding of insurance payer/provider claims processing and subsequent data requirements.
- Strong computer proficiency including MS Office (Word, Excel, and Outlook).
- Intermediate understanding of ICD, HCPCS/CPT coding, and medical terminology.
- Strong understanding of the revenue cycle process.
- Full understanding of hospital reimbursement, intermediate knowledge of Managed Care contracts, Contract Language, and Federal and State requirements.
- Familiarity with HMO, PPO, IPA, and capitation terms.
- Intermediate understanding of EOB, hospital billing form requirements (UB04), and familiarity with the HCFA 1500 forms.
- Demonstrated ability to review client/payer contracts to identify complex underpayments.
Responsibilities
- Review, evaluate, appeal, and follow up on outstanding, denied, underpaid, and other assigned claims using EnableComp’s proprietary software, systems and tools.
- Use payment documentation provided by payers and medical provider contract information to determine the correct reimbursement.
- Efficiently review hospital contracts to identify and collect cash payments from insurance companies, ensuring prompt payments of denied and underpaid claims.
- Research, request, and acquire all pertinent medical records and supporting documentation to create and submit complex underpayment appeals to the appropriate payer.
- Conduct timely and thorough telephone follow-up with payers to ensure claims with supporting documentation have been received and facilitate resolution of outstanding receivables.
- Ensure smooth operations and improve customer satisfaction.
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