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