Keystone Laboratory, Inc. - Asheville, NC

An exciting and challenging opportunity awaits a highly qualified Medical Insurance Billing & Reimbursement Analyst I in one of the most beautiful areas in the country, Asheville, NC. (http://www.exploreasheville.com/)

About Wolfe, Inc. / Keystone Laboratory Inc.

WOLFE, Inc. / Keystone Laboratory Inc., has been in the business of drug detection and workplace protection for nearly 30 years. We provide a comprehensive array of instant drug testing products and accessories, lab services, background screening, program management and training services for organizations of every size and type. In all we do, our number-one objective is to help all our customers achieve a safe, drug-free workplace—and to do so better and more cost-effectively than anyone else.

Summary/Objective

The Billing and Reimbursement Analyst is responsible for the maximization of reimbursements by contacting insurance carriers and/or 3rd parties daily to collect outstanding insurance balances due, resolve disputes, denials, and general non- payment issues. This position also assists in the management of patient balances, including the negotiation and recovery of outstanding balance.

Essential Functions

Responsibilities include but are not limited to the following:

• Have working knowledge of payer determinations, contract fees, covered or non-covered items, diagnosis, modifiers, valid HCPC, prescriptions, authorization, eligibility, etc.

• Monitor websites for payer policy changes and share information with leadership.

• Comply with all applicable Federal, State, and local laws, regulations, and requirements as well as Keystone Laboratory policies and procedures in all aspects of job performance.

• Adhere to payer timely filing limits and work accounts to resolve within payer timely filing parameters. Prepare, review, and transmit claims using billing software, including electronic and paper claim processing.

• Check eligibility and perform benefit verification, enter charges & transmit clean claims per coding, carrier, and contract guidelines.

• Assist in daily resolution on clearinghouse rejections.

• Perform due diligence in reconciling outstanding balances with payers, ensuring all efforts have been exhausted in resolving issues with payers prior to write-off.

• Send appeals when appropriate or provide medical documentation for medical necessity within timely filing limits.

• Research all payer refund requests, recoupments and credit balances for accuracy and appeal if appropriate.

• Process a variety of accounts receivable reports, proactively problem-solving claim issues by determining the appropriate follow up action that may include reviewing and writing an appeal for denials and submitting claims, when necessary, after payer contact.

• Ensure that goals set for claims, denials, suspensions, and appeals on aged accounts are met within the set deadlines established for department.

• Perform analysis of accounts receivable data and understand the reasons for underpayment, days in AR, top denial reasons, use appropriate codes to be used in documentation of the reasons for denials/underpayments.

• Communicate professionally with physician offices and all other referrals to obtain medical documentation necessary to secure payment.

• Maintain accurate and complete records concerning billing and collection activity including documenting the patient's chart and system notes.

• Maintain excellent customer service to both our client’s insurance carriers and our provider's patients by performing inbound and outbound calls to assist in any inquiries concerning account activity.

• Maintain confidentiality of all patient demographic, medical, and financial information, ensuring proper handling and disposal of confidential documents and adherence to HIPAA.

• Participate in team meetings to share identified non-payment trends or other appropriate feedback as it relates to payments and adjustments.

• Support department projects and initiatives established for the department.

• Review patient bills for accuracy and completeness and obtain any missing information and update as necessary, obtain updated insurance information or any other required information.

• Responsible for reviewing patient balances, collecting patient payments, applying to patient accounts, and following up to verify payment was received.

• Help educate patients on their financial responsibility for billed items and any applicable rules and regulations.

• Monitor and works Daily Reports to meet department daily contact and collection goals.

• Investigate payment status and determine ultimate patient financial responsibility and plans a course of action to collect outstanding balances by offering various financial options that can include patient financial assistance.

• Minimize patient distress with active listening, maintaining a professional tone, and acknowledging their concerns.

• Utilize collection techniques by direct telephone and written correspondence to resolve accounts according to the company's policies and procedures.

• Must be able to attend work on a regular and predictable basis.

• Must be able to work well, efficiently and with accuracy under the stress of deadlines.

• Must be able to complete assigned tasks in a safe manner and in a constant state of alertness.

  Basic Skills & Qualifications:

• Knowledge of medical insurance payers, billing rules, and regulations through experience in healthcare and/or medical industry.

• Knowledge of denials management, AR fundamentals, and experience working with a clearinghouse.

• Experience with medical terminology, insurance reimbursement, ICD-10, and CPT coding preferred.

• Significant experience using Microsoft Office - Word, Excel, PowerPoint, Outlook, and the ability to learn and adapt to internal software programs.

• Strong analytical skills with critical thinking capability to collect, analyze and interpret data, and resolve complex problems.

• Must be able to multi-task and prioritize tasks using strong organizational and time management skills.

• Must be able to work independently, paying particular focus on detail and adapt to a fast-changing environment.

• Must possess excellent interpersonal and customer relationship skills for interacting with patients regarding medical claims and payments.

• Must possess a positive, open, and friendly attitude with all clients and colleagues.

  Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit/stand; use hands to finger, handle, or feel; reach with hands and arms and talk or hear. The employee is required to stand and walk and sit while working. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, and ability to adjust focus.

  Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. General office and administrative work environment requiring use of computer, phone, and general office equipment, call center.

  Favorable Background Check and Passing Drug Test required for employment.

  Keystone Laboratory, Inc. is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, disability status or any other status protected by law.