Billing Denials Representative

Located at our Core Lab (Moraine, OH)/Remote Shift Availability 

Full-Time Day Shift

Position Summary:

Under the supervision of the Billing Department Manager: perform the daily account processing tasks of the Billing Department including billing data entry, third party billing and follow up; review denials and resubmit claims; answer incoming as well as place outgoing calls to both patients and clients while maintaining positive internal and external working relationships with patients, clients and third party payers.

Responsibilities:

• Maintain organized workflow for efficient account processing and seamless task handover during absences.
• Adhere to departmental processes, consulting supervisors when needed.
• Demonstrate strong customer service skills to enhance department and organizational reputation.
• Foster teamwork and meet or exceed work standards.
• Possess working knowledge of compliance regulations and apply them effectively.
• Follow company policies and maintain accurate statistical data.
• Accurately perform order entry and resolve missing information.
• Utilize translation tools for entering codes into billing systems.
• Communicate effectively with internal and external stakeholders.
• Apply payment details accurately and handle overpayments or refunds.
• Review Explanation of Benefits from various payers.
• Investigate un-adjudicated claims and resolve outstanding accounts.
• Process Medicare denials and monitor payer rejections.
• Handle fast-paced, high call volume environments with strong multitasking skills.
• Focus on positive customer impact and utilize effective verbal and written communication.
• Research collection accounts and correct system errors.
• Perform additional duties and projects as assigned.

Qualifications:

• High school graduate or equivalent required.
• Minimum of 1 year billing experience working denials.  
• Working knowledge of Medicare and other third-party claims processing, ICD-10 and HCPCS/CPT coding, and medical terminology highly desirable.

Safety & Physical Demands:

• Visual acuity and hand-finger dexterity for extended computer work.
• Ability to sit at computer workstation for prolonged periods.
• Sound reasoning ability and independent judgment.
• Capacity to work within specified deadlines.
• Excellent communication and interpersonal skills.
• Ability to remain calm in stressful situations.
• Adherence to safety, ergonomic and health policies.
• Compliance with PPE requirements in lab or biohazard areas.
• Completion of required safety training and health evaluations promptly.
• Proactive approach to identifying and addressing safety hazards, promoting safety awareness.