Role Summary:

The medical billing associate role entails ensuring that all medical billing requirements from different partners are adhered to, and that all the requisite clinical and patient documentation is well captured in every invoice.

Responsibilities:

• Thoroughly review claims for errors, accuracy, and completeness, rectifying any issues before submission to insurance companies. Provide direct feedback to medical centers/providers on identified errors.
• Coordinate pre-authorization and eligibility verification processes, ensuring compliance with insurance guidelines. Train medical center staff on insurance guidelines and provide consultation for compliance.
• Ensure timely dissemination of changes and communications from insurance partners to all medical centers. Maintain accurate record-keeping of invoices and communicate limits/exclusions to service points based on insurance guidelines.
• Support medical centers by identifying capacity gaps and providing training in medical billing. Liaise with the credit team to review disputed claims and provide clinical justification for appeals to insurance.
• Professionally respond to queries from insurance partners or medical centers regarding billing. Timely circulate memos to clinicians and clinical coordinators on new insurance guidelines.
• Scrutinize rejected claims related to clinical issues, providing guidance and coaching to medical centers to minimize claim denials. Submit invoices through designated portals  for processing.

Key requirements and attributes 

• Be a Clinical Officer at Penda.
• 1 year working experience at Penda.
• A great champion of Penda Way demonstrating strong leadership skills.
• A track record of great performance across all areas from the PR.