Position Summary
Under general supervision, performs various billing office functions including insurance follow-up, denial follow-up, resolution of contact variances, and ensures all actions of the billing responsibilities are performed accurately and efficiently to support patient satisfaction and financial stability of the organization.
Position Responsibilities
• Routinely monitors and manages insurance workqueues associated with insurance follow-up on primary, secondary, and subsequent payors. • Reviews and works with insurance companies to resolve unpaid facility and professional claims to ensure prompt payment. • Analyzes and investigates all insurance denials. • Performs a thorough, complex review of accounts including, but not limited to, authorization, charges, coding, and medical records to write an effective appeal to achieve a timely resolution. • Tracks denial patterns for trends, specific payor issues, and root causes. • Advises management and provides suggestions to improve processes to prevent future denials. • Investigates and interprets payment variances. • Reviews posting and explanation of benefits for payment, contractual adjustments, and patient responsibility. • Ensures reimbursement is in accordance with contracts, insurance plan benefits, and medical policies. • Posts manual adjustments or submits reconsiderations and appeals as necessary for effective resolution and accurate reimbursement. • Evaluates and investigates third party refund requests. • Appeals or processes refund requests as appropriate. • Initiates phone calls, utilizes website tools, and composes correspondence to engage with third party payors to rectify any payment concerns, discrepancies, or issues. • Corrects and resubmits claims to payors as appropriate. • Processes information from all sources to make decisions within scope of job functions with minimal supervision while demonstrating a high level of professionalism. • Researches and updates account insurance coverages. • Contacts patients by phone or letter for additional insurance information as needed. • Accurately and thoroughly documents all pertinent conversations, correspondence, actions, and activities performed on accounts to ensure progress is made. • Independently prioritizes and organizes work to ensure effective and efficient completion. • Work collaboratively with the Reimbursement Coordinator, Denials Coordinator, Health Information Management, Patient Access, and other departments as needed. • Assists in establishing and maintaining policies and procedures for billing and reimbursement activities to maintain quality assurance, optimal processes, and meet regulatory requirements. • Reports any observed or suspected deviation from medical center policies or from Medicare, Medicaid, or other insurance regulations immediately to the department Manager, Director, or the medical centers Compliance Officer. • Displays responsiveness and flexibility to adapt to changes in work environment and modify approaches or methods to best fit the situation. • Demonstrates effective interpersonal skills to work with others to resolve account issues and ensure a high degree of customer satisfaction. • Participates in staffing meetings, staff development, and training.
Performing Other Duties
• Performs other duties, responsibilities, and special projects as assigned.
Qualifications
Experience Required Qualifications (Including any licensure, certification, education):
• Two years of higher education and/or two years of progressively responsible work experience in a medical office or insurance company setting. • Equivalent combination of education and experience that would demonstrate the capability to perform the duties of the position.
Organizational Requirements:
• Maintain stroke education per regulatory requirements.
Preferred Qualifications:
• AAHAM Certified Revenue Cycle Specialist
Required Knowledge, Skills
Experience:
• Internet usage skill • Knowledge of Microsoft related programs such as Word, Excel, and Outlook • Excellent customer service skills • Detail orientated • Ability to analyze and interpret information to make decisions within scope of job functions with minimal supervision • Effective oral and written communication skills with the ability to clearly and concisely articulate issues • Ability to multitask while maintaining accuracy in a fast-paced environment
Preferred Knowledge, Skills
Experience:
• Considerable knowledge of billing claim forms • Considerable knowledge of the Federal and State regulatory requirements for billing accounts receivable • Considerable knowledge of Medicare, Medicaid, and/or insurance carrier billing and reimbursement • Understanding of medical terminology and diagnosis and procedure coding • System experience: Epic, Medicare RTP, OnBase, Experian