Billing Follow Up Representative I

Advocate Health and Hospitals Corporation•Charlotte, NC

1d•Onsite

About The Position

This position supports moderately complex processes related to billing, coding, and reimbursement. The primary responsibility is to actively follow up with insurance carriers on open insurance claims. The team member must have an understanding of contractual relationships and supports complete and timely revenue collection from patients and third-party payers through accurate entry and/or correction of patient, charges, and insurance information into the system. This role also identifies and brings patterns/trends to leadership for any potential delays or denials in reimbursement and verifies daily electronic claim submission.

Requirements

High School Diploma or General Education Degree (GED)
Typically requires 1 year of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience.
Must perform within the scope of departmental guidelines for productivity and quality standards.
Works independently with limited supervision.
Accountable and evaluated to organization behaviors of excellence
Basic keyboarding proficiency.
Must be able to operate computer and software systems in use at Advocate Aurora Health.
Able to operate a copy machine, facsimile machine, telephone/voicemail.
Ability to read, write, speak and understand English proficiently.
Ability to read and interpret documents such as explanation of benefits (EOB), operating instructions and procedure manuals.
Ability to communicate well with people to obtain basic information (via telephone or in person).

Nice To Haves

Knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC) and insurance/reimbursement practices.

Responsibilities

Independently review accounts and apply billing follow-up knowledge required for all insurance payors to ensure proper and maximum reimbursement.
Use multiple systems to resolve outstanding claims according to compliance guidelines.
Perform pre-billing/billing and follow-up activity on open insurance claims exercising revenue cycle knowledge (i.e., CPT, ICD-10 and HCPCS, NDC, revenue codes and medical terminology).
Obtain necessary documentation from various resources.
Timely and accurately communicate with internal teams and external customers (i.e., third-party payors, auditors, other entities) and act as a liaison with external third-party representatives to validate and correct information.
Comprehend incoming insurance correspondence and respond appropriately.
Identify and bring patterns/trends to leadership's attention regarding coding and compliance, contracting, claim form edits/errors, and credentialing for any potential delay/denial of reimbursement.
Obtain and stay abreast of insurance payer updates/changes, single case agreements, and assist management with recommendations for implementation of any edits/alerts.
Accurately enter and/or update patient/insurance information into the patient accounting system.
Appeal claims to assure contracted amount is received from third-party payors.
Comply with and maintain KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines.
Compile information for referral of accounts to internal/external partners as needed.
Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and follow-up efforts for each account, utilizing established guidelines.
Read and understand all Advocate Aurora Health policies and departmental collections policies and procedures.
Demonstrate proficiency in proper use of the software systems employed by AAH.
Refer to the supervisor for approval or final disposition such as recommendations regarding handling of observed unusual/unreasonable/inaccurate account information, approval needed to write off balances according to corporate policy, and issues outside the normal scope of activity and responsibility.

Benefits

Comprehensive suite of Total Rewards
Competitive compensation
Generous retirement offerings
Programs that invest in your career development
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program