Billing Follow Up Rep I

The Billing Follow Up Representative I is responsible for independently reviewing accounts and applying billing follow-up knowledge required for all insurance payors to ensure proper and maximum reimbursement. This role involves using multiple systems to resolve outstanding claims in accordance with compliance guidelines. The representative will engage in prebilling, billing, and follow-up activities on open insurance claims, utilizing their revenue cycle knowledge, including familiarity with CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology. They will also obtain necessary documentation from various resources to support their efforts. Effective communication is crucial in this position, as the representative must timely and accurately interact with internal teams and external customers, including third-party payors, auditors, and other entities. Acting as a liaison with external third-party representatives, they will validate and correct information as needed. The representative will comprehend incoming insurance correspondence and respond appropriately, identifying and bringing patterns or trends to leadership's attention regarding coding and compliance, contracting, claim form edits/errors, and credentialing that may lead to delays or denials of reimbursement. Additionally, the representative is responsible for accurately entering and/or updating patient and insurance information into the patient accounting system and appealing claims to ensure that the contracted amount is received from third-party payors. They must comply with and maintain Key Performance Indicators (KPIs) for assigned payers within the standards established by the department and insurance guidelines. The role also involves compiling information for referral of accounts to internal or external partners as needed and maintaining clear, accurate online documentation of all activity related to billing and follow-up efforts for each account, following established guidelines. The representative must read and understand all Advocate Aurora Health policies and departmental collections policies and procedures, demonstrating proficiency in the software systems employed by the organization.