Full time (80 hours biweekly)
Monday-Friday dayshift
Remote
General Summary
Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.
Duties and Responsibilities
Essential Functions:
- Corrects financial and demographic information that has been inaccurately entered into Epic.
- Performs various functions to complete and expedite the billing process including: - Reviews and submits Hospital and/or Physician claim forms (UB04, 1500, etc) to insurance companies via electronic or manual processes and facilitates special billing for split claims, ancillary charges, interim bills, etc.- Resolves Claim edits to facilitate timely billing and reimbursement.- Performs follow-up with insurance companies to obtain claim status, payment information and to resolve claim discrepancies.- Submits itemized bills, medical records, and corrected claims as needed.- Reviews remittance advice (835) to ensure proper reimbursement.- Accesses external payer sites for payer policies, claim investigations, and claim disputes.
- Reviews accounts and coordinates with appropriate departments on accounts requiring precertification, preauthorization, referral forms and other requirements related to managed care.
- Makes written and/or verbal inquiries to third party payers to reconcile patient accounts. Follows up on accounts until zero balance or turned over for collection.
- Reviews third party payer payments and investigates accounts not paid as expected. Takes appropriate corrective action to include follow up, rebilling, and/or adjustment of contractual allowances.
- Answers all inquiries regarding patient accounts.
Common Expectations:
- Maintains appropriate records, reports, and files as required.
- Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
- Participates in educational programs and in-service meetings.
- Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Qualifications
Minimum Education:
- High School Diploma or GED Required
Work Experience:
Knowledge, Skills, and Abilities:
- Excellent communication and interpersonal skills
- Familiarity with payer rules and policies
- Familiarity with healthcare billing systems (Epic preferred)
- Familiarity with medical and billing terms to help interpret edit resolution, claims remittance advice, medical record documentation and payer medical/payment policies
Benefits Offered:
- Comprehensive health benefits
- Flexible spending and health savings accounts
- Retirement savings plan
- Paid time off (PTO)
- Short-term disability
- Education assistance
- Financial education and support, including DailyPay
- Wellness and Wellbeing programs
- Caregiver support via Wellthy
- Childcare referral service via Wellthy
