EOB Specialist who will be responsible for monitoring denials, appeals and resolutions from participating insurance carriers and working proactively to collect from insurance carriers.
Job Title: EOB (explanation of Benefit) Specialist
Reports to: Accounts Receivable Manager
- Responsible for timely & accurate receipt of payments of all contracted & non-contracted clients
- Ensures maximum and correct reimbursement responses on all AR- IV infusion, wound care, Physical Therapy, Home Health Care, Dental etc.
- Utilizes and applies the appropriate CA and federal regulations to assure compliance of payment practices
- Proactively works with in-house resources and payers to identify and resolve ongoing issues that hinder optimal payment and corrects ongoing deficiencies
- Utilizing many complex and varying regulations, guidelines and systems, analyzes payments received from insurance companies to assure maximum and correct reimbursement
- Confers with the management team to identify and resolve any noticeable patters of errors
- Analyzes Explanation of Benefits (EOB) statements and adjust accounts according to MTI claims processing criteria
- Oversees and interacts with other MTI departments and team members regarding certain administrative operations within practices. This includes but is not limited fees, pre-authorizations, billing, auditing, and claims follow-up
- Ensures compliance with Company policies, as well as State, Federal and other regulatory bodies
- Other duties as assigned
- Minimum 4-6 years of related experience in medical billing/AR operation
- Bachelors’ degree in business finance or a related field required.
- Knowledge of how to read and interpret EOB’s (explanation of benefits)
- Demonstrated knowledge of insurance billing relating to medical service reimbursement
- Ability to plan, organize and prioritize work
- Good interpersonal skills and communication with all levels of management
- Able to multitask, prioritize, and manage time efficiently
- Excellent verbal and written communication skills
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.
Individuals may need to sit or stand as needed. May require walking primarily on a level surface for periodic periods throughout the day. Reaching above shoulder heights, below the waist or Lifting as required to file documents or store materials throughout the work day. Proper lifting techniques required. May include lifting to 3 pounds for files, computer printouts on occasion.
For roles located in the field; this job is primarily active; the employee is regularly mobile and must be able to utilize transportation (such as driving), sit, use hands, and fingers speak, and hear.
Auditory/Visual: Hearing, vision, and talking. Specific vision abilities required by this job include ability see things from a close distance and ability to adjust focus
Work Environment: Utilizes fluorescent lighting; noise level is moderate. For the most part ambient room temperatures, lighting and traditional office equipment as found in a typical office
The Job Description is subject to change at any time
MTI is an Equal Opportunity Employer
By submitting a resume for this position, you authorize MTI to contact you via phone, email, or text message to coordinate an interview