Essential Duties and Responsibilities

• Primary Job Responsibilities

  • Resolve the more intricate billing edits as assigned. The edits are the result of claims that have previously billed and require an increased ability to understand what happened initially and the additional requirements that are needed to rebill successfully.

  • Follow up on the No Response WQs as assigned. Communicate with the payer via phone, email, or website platforms as needed. Ability to locate denial or remittances via the payer websites as needed.

  • Respond to denials received on accounts as assigned. This may require a re-billing of a claim after updating the correct information or it may require the submission of an appeal with supporting documentation.

  • Collaborate professionally internally or with external departments when needed to resolve the edit or denial. This may require consistent communication with coding or individual departments. For those that have coding certifications, the collaboration with Coding will be complementary and beneficial to both areas.

  • Identify and present the payer trends amongst the claims that are editing for similar reasons. Communicate and work with the leaders to mitigate. The expectation is that this role can work all billing edits and will serve as a resource to the Medical Billing Associate as needed.

  • Identify payer trends within the denials and work with leaders to mitigate those denials where possible. The goal is to minimize the aging AR.

  • Proper and detailed notation of actions taken on the account. Others will rely on those notes when taking the next step on the account follow up.

  • Payer Website navigation as needed to obtain information. Review, understand, and locate payer policy guidelines as required. Ability to locate claim adjudication details with the supporting documentation.

  • Proficient use of Epic, On Base, and other platforms as needed.

  • Ability to work independently and under time constraints and deadlines and with minimal supervision. Able to prioritize workload in an effective manner. Begin to articulate possible avenues to resolve claim challenges.

  • Meet daily/weekly productivity standards with acceptable QA results.

  • Other duties as assigned.

• Revenue Cycle Management

  • This position will identify accounts that need to be placed on the payer agendas as they are not being resolved through the normal dispute process. The accounts are aging on the accounts receivable. Concentration on the AR > 60 days.

  • Identification and communication of payer trends that are negatively impacting the overall AR.

  • Timely and professional communication with outside departments to resolve the billing or follow-up challenges. Consistent and responsive communication with Patient Access and Coding are a must.

  • Identification of department trends that need to be brought to Management to address with the departments. Participate as needed and at the request of leadership. These could include practices, hospital departments, as well as departments within the revenue cycle.

  • Build an understanding of expected reimbursement on the accounts to ensure correct payments are received.

  • Build an understanding of the reports provided by leadership as it pertains to the assigned task or assignment.

Qualifications

• High School Diploma/G.E.D. - required

• Associate's Degree - preferred

• Prior office experience - preferred

• Medical Billing or claims knowledge - preferred

• Ability to work independently and within a team

• Excellent verbal and written communication skills.

• Ability to communicate with internal peers and leadership

• Demonstrates an ability to learn and understand instruction

• Ability to effectively prioritize and execute tasks in a high-volume atmosphere.

• Microsoft Office and website knowledge

• CCS-Certified Coding Specialist Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) Upon Hire - preferred

Equivalent combination of relevant education and experience may be substituted as appropriate.