We are seeking to bring on an HMO Biller to join our team.
HMO Billers specialize in managing and reducing the financial risks associated with unpaid invoices and customer defaults, including providers not limited to Managed Care policies.
Responsibilities include assessing creditworthiness, developing insurance policies, and underwriting applications, managing policy administration, handling claims, and maintaining client relationships.
Responsibilities • Accurately process insurance claims submitted by healthcare providers on behalf of their patients.
• Verify patients' insurance coverage, recode, and resubmit claims electronically or via paper forms, and ensure that all necessary documentation is attached.
• Verify patients' insurance coverage and eligibility by contacting insurance companies, reviewing insurance plans, and obtaining necessary authorizations or referrals.
• Monitor the status of claims, identify, and address any issues or rejections, and take necessary actions to resolve them.
• Communicate with insurance companies, provide additional documentation or information, and appeal denied claims.
• Maintain proper documentation of all insurance-related activities and ensure compliance with regulatory requirements.
This involves keeping accurate records of claim submissions, payments, and denials, as well as maintaining patient confidentiality and privacy.
• Identify opportunities for process improvement and efficiency.
This may involve implementing new technologies or software systems, streamlining workflows, and staying updated with changes in insurance regulations and coding practices.
• Once the payment is received, handle inquiries related to invoices, resolve discrepancies, and address any issues related to payments.
This is not limited to reprocessing the bills while continuing timely filling per Medicare Guidelines.
• Any new regulation pricing updates require to be rearranged for the following billing cycle to reduce discrepancies.
Requirements • A strong understanding of insurance terminology, policies, and procedures is essential.
• Proficiency in medical billing and medical coding systems such as ICD-10 and CPT and understanding of how to assign appropriate codes for procedures, diagnoses, and services depending on the type of service rendered.
• Strong analytical skills to review and interpret insurance policies, coding guidelines, and reimbursement rules.
Identify patterns in claims denials or payment discrepancies, conduct root cause analysis, and develop strategies to optimize reimbursement.
• Strong problem-solving and decision-making skills to navigate through such situations, identify solutions and make sound judgments to resolve issues in a timely manner.
• The healthcare and insurance industries are constantly evolving.
Being adaptable to change and having a willingness to learn and stay updated with new regulations, coding guidelines, and industry best practices is crucial for long-term success.
It's a must.
About Us At Insignia Resources, we believe in investing in our employees' success.
We offer a supportive and collaborative work environment that encourages creativity, learning, and continuous improvement.
As a member of our team, you'll have access to cutting-edge resources, training programs, and mentorship opportunities to enhance your skills and propel your career forward.
Joining Insignia Resources means joining a network of talented professionals who are passionate about making a difference.
We value a culture that celebrates individuality and promotes teamwork.
Our employees are the driving force behind our success, and we recognize and reward their contributions through competitive compensation packages, performance-based incentives, and comprehensive benefits.
As a part of our team, you will have the opportunity to work with industry-leading clients and gain exposure to exciting projects across a wide range of sectors.
Whether you're an experienced professional or just starting your career, Insignia Resources provides a platform for you to thrive and realize your full potential.