Provides comprehensive analysis expanding all aspects of insurance claims billing, follow up and collections, including direct contact to the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal. Resolves all billing related issues and manages unpaid claim related inquiries. Assists with onboarding activities and training of other team members as necessary.
- Ensures efficient processing of denials and appeals. Meets cash collection goals by reviewing, analyzing, completing, and submitting appropriate documentation based on payer requirements. Conducts research and provides updates and current status of collection efforts using the appropriate data management systems (EPIC/Meditech).
- Performs extensive follow-up and collections for third parties, resolving issues that are adversely impacting claims payment. Communicates information and ideas to make system-wide process improvements. Updates data regarding changes and modifications in plan benefits and other contract information relevant to billing or claims follow up and collection processes. Completes special projects as assigned.
- Serves as a communication link to various departments, external payers or vendors by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the organization. Performs liaison services to both internal and external customers providing assistance in billing, collections and claims resolution. Reviews and responds to correspondence and inquiries generated by third party payers. Provides medical record copies and other pertinent information to the appropriate sources throughout the collection process.
- Assists with education of internal staff and external customers to bring about the timely, accurate, and cost effective adjudication of all claims. Works collaboratively with other departments to facilitate the insurance collection process and to improve overall cash collection.
- Communicates team barriers, process flow or productivity issues to the supervisor/manager. Assists team members with onboarding, operational support and training. Assists in resolving claim issues requiring additional oversight by tracking and trending information and conducting root cause analysis.
- Monitors the status of denials, appeals, and claim errors by using work queues and conducting routine, periodic follow up and collection on previously researched claims items. Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to secure timely payment.
- Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment. Maintains awareness of current regulations. Initiates practices that support current regulations. Shares knowledge of current regulations with staff. Analyzes current practices and makes recommendations for process improvements.
- Assists other departments/functional areas as needed with denials, billing, collections and claims follow up related tasks.
- Participates in committees as a representative for the department's interests, objectives, and/or goals.
- Performs other duties as assigned or required.
- 3-5 years of health care experience or associates degree + 1 year
- Associate's Degree/completion of college level coursework
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
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