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Accounts Receivable

hace 2 semanas

San José, San José, Costa Rica APEX IONM SOLUTIONS A tiempo completo

Key Responsibilities

  • Follow
    APEX IONM SOLUTIONS Billing SOP Manual
    protocols and payer-specific guidelines, as well as direction from the Director of Billing Operations.
  • Research missing, delayed, or rejected claims to identify root causes and prevent duplicate submissions.
  • Manage assigned claims from submission through resolution, ensuring closure in accordance with billing SOPs.
  • Review and maintain up-to-date payer-specific billing procedures within the Insurance Billing SOP.
  • Contact insurance payers to follow up on claims after reviewing EOBs or claim notes to ensure timely payment.
  • Analyze EOBs to determine the need for appeals, reconsiderations, or corrected claims, ensuring accurate CPT, ICD-9/ICD-10 codes, modifiers, and sequencing.
  • Verify that medical records accurately support billed services before submission to insurance payers.
  • Prepare appeal letters and compile supporting documentation for partially or fully denied claims.
  • Proactively identify and resolve incomplete claims to expedite payment.
  • Document all actions taken on claims clearly and accurately within the billing system.
  • Review unpaid claims for interest and penalty eligibility in compliance with
    Senate Bill 418
    .
  • Maintain and update insurance payer CRM databases and communication guidelines.
  • Collaborate with Patient Care Advocates to obtain patient assistance when needed.
  • Communicate respectfully and professionally with patients, payers, and internal teams.
  • Identify and escalate potential insurance fraud concerns as required.
  • Perform additional duties as assigned.

Required Skills & Abilities

  • Excellent verbal and written communication skills
  • Proficiency in Microsoft Office Suite and medical billing software
  • Strong organizational skills with high attention to detail
  • Ability to work independently and in a fast-paced environment
  • Professional, solution-focused mindset