Billing Follow Up Representative I

Advocate Health and Hospitals Corporation•Sheboygan, WI

2d•Hybrid

About The Position

This full-time position is in the Enterprise Revenue Cycle - Special Program Billing Ops department. The role involves reviewing accounts, applying billing follow-up knowledge for all insurance payors to ensure proper and maximum reimbursement. The representative will use multiple systems to resolve outstanding claims according to compliance guidelines, perform pre-billing, billing, and follow-up activities on open insurance claims, and utilize revenue cycle knowledge including CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology. The role also includes obtaining necessary documentation, communicating effectively with internal teams and external customers, comprehending and responding to insurance correspondence, identifying trends in coding, compliance, contracting, claim form errors, and credentialing, and staying updated on insurance payer changes and single case agreements. The representative will also enter and update patient/insurance information, appeal claims, maintain Key Performance Indicators (KPIs), compile information for referrals, and maintain accurate documentation of all activity. This position requires adherence to Advocate Aurora Health policies and departmental collection policies and procedures, and proficiency in software systems. The role refers to a supervisor for approvals on write-offs, unusual account information, and issues outside the normal scope of responsibility.

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.

Nice To Haves

Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC) and insurance/reimbursement practices.
Ability to communicate well with people to obtain basic information (via telephone or in person).

Responsibilities

Independently review accounts and apply billing follow up knowledge required for all insurance payors to insure proper and maximum reimbursement.
Uses multiple systems to resolve outstanding claims according to compliance guidelines.
Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge (ie;CPT,ICD-10 and HCPCS, NDC, revenue codes and medical terminology).
Obtain necessary documentation from various resources.
Ability to timely and accurately communicate with internal teams and external customers (ie; third party payors, auditors, other entity) and acts as a liaison with external third party representatives to validate and correct information.
Comprehends incoming insurance correspondence and responds appropriately.
Identifies and brings patterns/trends to leaderships attention re:coding and compliance, contracting, claim form edits/errors and credentialing for any potential in delay/denial of reimbursement.
Obtains and keeps abreast with insurance payer updates/changes, single case agreements and assists management with recommendations for implementation of any edits/alerts.
Accurately enters and/or updates patient/insurance information into patient accounting system.
Appeals claims to assure contracted amount is received from third party payors.
Complies and maintains 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.
Responsible to 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.
Refers 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 balance’s according to corporate policy.
Issues outside normal scope of activity and responsibility.

Benefits

Comprehensive suite of Total Rewards: benefits and well-being programs
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