Billing Follow Up Rep. I

Responsibilities

• Independently review accounts and apply billing follow-up knowledge required for all insurance payors to ensure proper and maximum reimbursement.
• Use multiple systems to resolve outstanding claims according to compliance guidelines.
• Perform pre-billing, billing, and follow-up activity on open insurance claims using revenue cycle knowledge (e.g., CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology).
• Obtain necessary documentation from various resources.
• Communicate timely and accurately with internal teams and external customers (e.g., third-party payors, auditors) and act as a liaison with external representatives to validate and correct information.
• Comprehend incoming insurance correspondence and respond appropriately.
• Identify and bring patterns/trends to leadership’s attention regarding coding, compliance, contracting, claim form edits/errors, and credentialing for potential delays/denials in reimbursement.
• Obtain and stay updated with insurance payer changes, single case agreements, and assist management with recommendations for implementation of edits/alerts.
• Accurately enter and/or update patient/insurance information into the patient accounting system.
• Appeal claims to ensure contracted amounts are received from third-party payors.
• Comply with and maintain KPIs (Key Performance Indicators) for assigned payers within departmental and insurance guidelines.
• Compile information for referral of accounts to internal/external partners as needed.
• Maintain clear, accurate, and up-to-date online documentation of all billing and follow-up activity for each account, following established guidelines.
• Read and understand all Advocate Aurora Health policies and departmental collections policies and procedures.
• Demonstrate proficiency in the proper use of software systems employed by AAH.
• Refer to the supervisor for approval or final disposition on recommendations regarding unusual/unreasonable/inaccurate account information, write-offs according to corporate policy, and issues outside the normal scope of activity.

Requirements

• High School Diploma or General Education Degree (GED).
• Typically requires 1 year of related experience in a medical/billing reimbursement environment, or an equivalent combination of education and experience.

Skills

• Perform within the scope of departmental guidelines for productivity and quality standards.
• Work independently with limited supervision.
• Basic keyboarding proficiency.
• Operate computer and software systems in use at Advocate Aurora Health.
• Operate a copy machine, facsimile machine, telephone/voicemail.
• Proficient in reading, writing, speaking, and understanding English.
• Ability to read and interpret documents such as explanation of benefits (EOB), operating instructions, and procedure manuals.
• Preferred but not required: knowledge of medical terminology, coding (CPT, ICD-10, HCPC), and insurance/reimbursement practices.
• Ability to communicate effectively with people to obtain basic information (via telephone or in person).