Insurance Follow-up Specialist I - Coding

Job ID: J128229
Company: West Penn Allegheny Health System
Location: Pittsburgh, PA, United States
Facility: 4 Allegheny Center
Full/Part Time: Full time
Job Type: Regular
Posted at: Aug 3, 2018

Share:

Description

GENERAL OVERVIEW:

Provides extensive support covering all aspects of insurance claims follow up, including direct contact to the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal. Manages all unpaid claims related inquiries.

ESSENTIAL RESPONSIBILITIES:

  • 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 system (EPIC PB). Performs extensive follow-up to 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 the claims follow up and collection process. (25%)
  • Serves as a communication link to various departments and external payers 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 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 collections process and to improve overall cash collection. (20%)
  • Monitors the status of denials, appeals, and claim errors by using work queues and conducting routine, periodic follow up on previously researched claims items. Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to secure timely payment. (20%)
  • 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. (15%)
  • Assists other departments/functional areas as needed with billing, claims, or claims follow up related tasks. (10%)
  • Participates in committees as a representative for the department's interests, objectives, and/or goals. (5%)
  • Performs other duties as assigned or required. (5%)

QUALIFICATIONS:

Preferred

  • Associate's Degree/Completion of college level coursework
  • Three years of previous medical billing and collections experience
  • Previous experience working with third party payers

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
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

Share:

Interested in working at the Highmark Health enterprise?
Take the first step by joining our Talent Network today!

Join Our Talent Network

Similar Jobs

Senior Accountant

Pittsburgh, PA, United States
Finance

Manager, Operational Accounting

Pittsburgh, PA, United States
Finance

CBO Professional

Pittsburgh, PA, United States
Finance

CBO Professional

Pittsburgh, PA, United States
Finance

Senior Actuarial Analyst

Camp Hill, PA, United States
Finance

Single Billing Office Representative

Pittsburgh, PA, United States
Finance

Accountant

Pittsburgh, PA, United States
Finance

Insurance Follow-up Specialist I - Coding

Pittsburgh, PA, United States
Finance

Senior Underwriter - Renewal Underwriting

Camp Hill, PA, United States
Finance

SR FINANCIAL ANALYST

Pittsburgh, PA, United States
Finance

Financial Analyst

Pittsburgh, PA, United States
Finance

Senior Underwriter - Renewal Underwriting

Pittsburgh, PA, United States
Finance

Associate Revenue Cycle Trainer

Pittsburgh, PA, United States
Finance

Lead Financial Analyst - Clinical Transformation

Pittsburgh, PA, United States
Finance

Director, Finance - Home Medical Equipment

Pittsburgh, PA, United States
Finance

Director, Finance - Home Medical Equipment

Fox Chapel, PA, United States
Finance

Actuarial Analyst

Pittsburgh, PA, United States
Finance

Underwriter     

Pittsburgh, PA, United States
Finance

Senior Managed Care Reinsurance Underwriter-3

Home, PA, United States
Finance

CBO Professional

Pittsburgh, PA, United States
Finance

Single Billing Office Representative

Pittsburgh, PA, United States
Finance

Single Billing Office Representative

Pittsburgh, PA, United States
Finance

Senior Managed Care Reinsurance Underwriter-3

Miami, FL, United States
Finance

RCO Facility Liaison

Pittsburgh, PA, United States
Finance

CBO Professional

Pittsburgh, PA, United States
Finance