Third Party Receivables Biller

Lehigh Valley Health Network•Allentown, PA

5d•Remote

About The Position

Participates in any or all aspects of the claim submission to third party carriers, incorporating industry best practices to ensure all state and federal billing guidelines and regulations are satisfied. Conducts root cause analysis of claim edits to determine corrective action to facilitate timely submission of claims and enhance the clean claim rate.

Requirements

High School Diploma/GED
2 years of professional or facility billing and/or collections for all major third party payers or work experience in healthcare related field.
Knowledge of third party reimbursement.
Knowledge of insurance contracts and regulations.
Must maintain high-level knowledge of claim submission requirements.
Strong analytical, mathematical, and organizational skills.
Experience working with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook).
Successful completion of DOE and Revenue Cycle Education within 3 months of hire.

Nice To Haves

Associate’s Degree Healthcare Administration, Finance or Business or CPAT - Certified Patient Accounting Technician - State of Pennsylvania

Responsibilities

Analyzes claim edits and conducts root cause analysis to resolve the edit, identifying opportunities for work flow process improvement and claim logic implementation to enhance the clean claim rate.
Monitors claim rejections from insurance carriers, taking the corrective action necessary to resubmit the claim, escalating rejection trends to department leadership for the creation or modification of claim edits, claim rules, or for escalation to the provider rep.
Maintains working knowledge of all regulatory claim form requirements, coding rules, LVHN protocols, as well as being proficient in all payer specific billing requirements.
Participates in claim rebill projects to address updates to items such as payer contract modifications, CDM updates, correction to charge errors, and coding version changes.
Maintains a positive and productive relationship with other LVHN Revenue Cycle Departments, instituting best practices to reinforce workflow standardization and optimize productivity.
Processes late or corrected charges according to billing guidelines for payers, submitting late replacement claims, corrected claims, or processing late charge write-offs.
Compiles documentation necessary for submission of paper claims: claim attachments, investigation of payer address, claim number; resolves eligibility situations, when necessary.