Sentences with phrase «payer of medical claims»

PLEASE NOTE: Medicaid and V.A. health plans do not constitute primary health insurance because they are not defined as the first payer of medical claims.

Not exact matches

Chunyu, a Chinese mobile healthcare app company that connects patients and doctors, raised $ 50 million from China International Capital Corporation (CICC), Rushan Venture Capital under DunAn Holding Group, Pavilion Capital run by Temasek, and BlueRun Ventures, and HealthEdge, a provider of a cloud - based or on - site integrated financial, administrative and clinical software platform for healthcare payers focusing on medical claims and benefits management brought in $ 30 million

The group, the United Seniors Association, a conservative alternative to the American Association of Retired Persons, sued Philip Morris, R.J. Reynolds and other cigarette makers, claiming standing as a private attorney general under the Medicare Secondary Payer statute, which creates a private cause of action against those primarily responsible for Medicare - covered medical expenses.

The Medical Billing and Coding Specialist is responsible for timely submissions of accurate insurance claims to all payers with subsequent timely follow - up and collection.

-- Timely submission of claims, processing of referrals and review of Medicare claims while complying with relevant rules and regulations — Preparing medical billing statements for payers and patients — Distributing mail and working with payers and patients in regards to billing as related to services rendered — Correctly producing account invoices and implementing corrective measures when needed — Processing specialized billing reports for all parties involved — Maintaining spreadsheets and other reports

• Working knowledge of ICD - 9 and ICD - 10 and OASIS • Excellent skills in reviewing delinquent accounts and creating avenues for overdue payments • Demonstrated expertise in translating medical procedures into codes that can be easily translated by payers and medical facilities • Proficient in appropriately and confidentially handling patient treatment, diagnosis and procedural information • Well - versed in investigating rejected claims and ensuring that they are resubmitted and paid • Special talent for investigating insurance fraud and determining ways to counter / avoid sticky situations • Skilled in verifying and completing charge information in company defined databases • Familiar with documentation needs (and manners of obtaining them) for insurance claims submission and approval • Qualified to work efficiently with external collection agencies to ensure maximization of reimbursement • Particularly effective in handling appeals for denials by employing exceptional knowledge of carriers and appeal processes • Special talent for increasing reimbursements by investigating denied claims and providing alternatives to denials

The Billing Clerk is a member of the medical office team whose primary responsibilities are the processing of insurance and other third party payer claims.

> Captures patient care data for the initial claim preparation > Registration of all patients, including insurance verification > Responsible for accurate and timely preparation of billing data > Validates all appropriate coding data for daily processing > Prepares electronic claims for submission to the appropriate payer > Obtains and submits copies of medical documentation as required or requested by third party payers > Reconciles insurance / patient payments > Assists in deposit preparation > Analyzes and resolves claim rejections and denials related to billing or provider issues > Assists in the compilation of monthly reports > Prepares, reviews, and completes patient statements submissions > Answers patient questions, identifies and resolves patient billing complaints > Assists in delinquent account review > Other duties as requested by the Billing Manager

• Track record of managing medical payment collection activities by indulging in extensive medical billing activities • Demonstrated expertise in acting as a liaison between medical facilities and insurance carriers including HMOs, PPOs, Medi - cal and Medicare • First - hand experience in using coded data to produce and submit claims to insurance companies to ensure prompt payments • Competent at reviewing and appealing unpaid and denied claims • Documented success in effectively and efficiently translating medical procedures into codes which can be easily translated by payers and medical facilities • Familiar with transmitting coded patient treatment information to intended recipients • Proven record of coding treatment information using designated CPT codes and effectively reviewing medical records for accuracy and integrity • Unmatched ability to create reimbursement claims and coordinate reimbursement activities with payers • Qualified to process patient data such as treatment records and insurance information to verify data accuracy and integrity • Proven ability to liaise with insurance companies to facilitate payments of outstanding claims • Particularly effective in verifying coding and billing information to ensure that outstanding payments are paid on time

CAREER HIGHLIGHTS • Over 5 years» dedicated experience in medical billing and coding field • Highly skilled in generating pre-bills and transmitting claims • Well versed in following up with payers, vendors and clearing agencies • Hands - on experience in resolving denial log entries running reports • Working knowledge of ICD - 9 / 10 and CPT coding, medical terminology and diagonosis procedures

Duties may include but are not limited to: • Review charges and file claims electronically • Post insurance and patient payments • Run error reports and make corrections as needed • Work denied or incorrect claims • Review accounts for collection and send to outside agency if necessary • Process and send patient statements • Prepare patient and insurance refund requests and respond to requests for recoupment and / or overpayment from an insurance company or payer • Answer and resolve all patient inquiries about payments and insurance • Answer requests and inquiries from insurance companies and other agencies seeking information related to claims • Stay informed of insurance news and regulation changes • Ensure compliance with Medicare and third party payers» procedures and protocol • Assist all employees in the understanding of new policies implemented by insurance carriers • Maintain EOB files EDUCATION AND EXPERIENCE: • A minimum of a High School diploma • A minimum of five years of billing experience in a medical office setting.

10 years of experience as a medical office receptionist with knowledge of various medical insurance payers Experience using proprietary medical claims processing software / applications Strong organizational,...

Expedites and maximizes payment of insurance medical claims by contacting third party payers and patients.