SHIFT:

• 1. Accounts Receivable Follow-up with assigned payers.
• Maintains Accounts Receivable goals of assigned payers including AR days and % of AR greater than 90 days
• Ensure all edit and rejection reports Paper or electronic are completed and appropriate action was taken.
• Inform Supervisor of any discrepancies related to billing and/or insurance companies on a weekly or immediate basis when a crisis may arise.
• Informs management of any payer trends
• Responsible for special projects for assigned payers
• Responsible for ensuring complete reviews of claims, identifies and researches any problems and forwards to appropriate insurance company.
• 2. Responsible for completing review of electronic claim rejections for assigned payers
• Responsible for reviewing claims for rejection, pending or accepted status of assigned payers
• Rejected claims are to be reviewed by the A/R representative for appropriate follow-up.
• Responsible for ensuring appropriate action is completed within the same business day and returned.
• Any issues with claims pending, or remitted are to be reported to the Supervisor immediately
• 3. Responsible for review of appropriate action for completed refunds/credit balances.
• Responsible for reviewing and assuring appropriate action of a completed refund to an insurance company or responsible party.
• Responsible to enter approved refunds/offsets with the appropriate action code within one (1) business day of receipt. When this is complete forward to receptionist or designee to enter the detail information in the appropriate offset or refund spreadsheet log for tracking purposes.
• Continue to maintain expected measures and standards of an Account Representative
• Inform Supervisor of all outstanding and unresolved issues related to billing or insurance companies on a weekly basis, or immediately if necessary.
• 4. Contacts insurance carriers or other responsible parties to confirm payment dates, question why a claim was rejected or question why a claim was not processed.
• Does all necessary follow up to obtain payment of claims; including but not limited to, claim status and intervention
• Reviews entire accounts to ensure claims were billed properly, payments were applied correctly and all necessary adjustments were made 100% of the time.
• Gathers all necessary documentation needed in order to have claims paid.
• Informs supervisor of any problems that arise 100% of the time.
• Records all pertinent comments and follows up accordingly, always following the guidelines set forth by management.
• Documents each contact in accordance with department guidelines
• Responsible for denial management for assigned payors; this will include review, follow up and escalation to management as required. Responsible for preparing, submitting and follow up of appeals for assigned payors.

• High School Diploma / GED Required

• At least two (2) years of billing experience Required

• Intermediate knowledge of insurance billing requirements for third party payors.
• Intermediate proficiency with office software (Microsoft Office)
• Intermediate proficiency with billing software (Microsoft Office)
• Familiarity with electronic medical records systems (EPIC)
• Solid verbal and written communications skills
• Solid analytical skills
• Solid critical thinking / problem-solving skills
• Ability to maintain confidentiality and professionalism
• Ability to work independently with minimal supervision
• Ability to gather, analyze and make recommendations/decisions based on data
• Ability to convey complex or technical information in an easy-to-understand manner
• Ability to collaborate with stakeholders at all levels