Include Ensure patient demographic information is accurate and complete Utilize customer hospital systems or approved vendors to research and obtain/verify patient demographic information Validate signature documents such as AOB (Assignment of Benefits), consents, CMN (Certificate of Medical Necessity) Verify patient name is consistent on all documents Verify date of servi

ESSENTIAL DUTIES AND RESPONSIBILITIES Serves as a subject matter expert with regards to all aspects of skilled nursing billing processes and the respective biller roles. Maintaining an advanced knowledge of payor updates including Federal and State guidelines, department workflows and resources needed to resolve payor rejections, billing errors and troubleshoot identified

Verifies claims are received by the payer and follows up to obtain payment via phone calls, portal or website use. Reviews claim adjustment reason codes or explanations of benefits received by the payer to determine what reasons for denials records are indicating for appropriate follow up. After denial review, evaluates next steps and takes action to call payer, follows u

Research and preform audits on patient accounts to determine balances are being billed to the correct payer. Thorough understanding of how to identify if charges on a patient's account are correct. In depth understanding of what information is available to assist in the process, such as the medical records, chart view, MPI, etc. In depth understanding of collection laws p

The Revenue Cycle System Specialist assists to build/maintain/correct systematic issues to ensure timely and accurate processing of claims, appeals, denials, and statements for Exact Sciences. A Systems Specialist demonstrates proven medical insurance knowledge by analytically identifying and resolving billing discrepancies regarding eligibility, denials, appeals, and age