Medical Billing Coordinator

All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules.

ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. We also offer paid holiday, sick time, and vacation time as well as a 410k plan. Additional employee paid coverage options available.

The Medical Billing Coordinator ensures timely and accurate reimbursement by managing outstanding claims and collaborating with insurance carriers, providers, and billing teams. This role requires strong problem-solving skills to resolve complex billing issues and maintain compliance with industry standards. This person will be key to early detection of problems ensuring claims are processed accurately and promptly. The position plays a key role in maintaining client satisfaction, providing critical support to ensure the financial health of our clients and growth for our company.

Strong written and verbal communication skills are essential for interacting with clients and insurance representatives.

• Claims Management:
  • Conducts timely and accurate follow-up on professional services claims to ensure all requested information has been submitted and claims are being processed utilizing payor portals, secure chat, secure messaging, and telephone calls.
  • Identifies missing payments from the health plan and initiates tracking procedures.
  • Reviews incoming correspondence from health plans and takes appropriate action or escalates to designated team members as needed.
  • Identifies pending claims and determines next steps required to obtain reimbursement for claim.
  • Uses existing queries to review limited new denials for processing errors, appropriately assigns a status based on review, corrects any internal errors and resubmits claims as necessary.
  • Follows up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution.
  • Monitors incoming messages from providers and responds to the provider or escalates the request to the appropriate team member.
  • Identifies claims with more complex issues and escalates them to the appropriate team member for resolution as needed.
  • Research health plan reimbursement policies and procedures, clinical guidelines, coding, and CCI edits to ensure claims are billed appropriately.
  • All other duties as assigned.
• Communication:
  • Communicate effectively with insurance companies, healthcare providers, and their billing staff to resolve claims issues and answer inquiries.
  • Document all interactions and updates in the claims management system.
• Documentation and Reporting:
  • Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures.
  • Prepare and submit reports on claim follow-up activities and status updates to management as requested.
• Compliance:
  • Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements.
  • Stay updated on changes in insurance policies, regulations, and industry standards.
  • Must meet quantitative production standard of working 100 – 150 claims per week.
  • Attend departmental and company meetings as required.
• Problem Resolution:
  • Identify and report trends which could have an overall negative impact on claim payments such as…