Billing Follow-up Rep I

Major Responsibilities

• Independently review accounts and apply billing follow up knowledge required for all insurance payors to insure proper and maximum reimbursement.
• Uses multiple systems to resolve outstanding claims according to compliance guidelines.
• Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge (ie;CPT,ICD-10 and HCPCS, NDC, revenue codes and medical terminology).
• Will obtain necessary documentation from various resources.
• Ability to timely and accurately communicate with internal teams and external customers (ie; third party payors, auditors, other entity) and acts as a liaison with external third party representatives to validate and correct information.
• Comprehends incoming insurance correspondence and responds appropriately.
• Identifies and brings patterns/trends to leaderships attention re:coding and compliance, contracting, claim form edits/errors and credentialing for any potential in delay/denial of reimbursement.
• Accurately enters and/or updates patient/insurance information into patient accounting system.
• Appeals claims to assure contracted amount is received from third party payors.
• Complies and maintains KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines.
• Compiles information for referral of accounts to internal/external partners as needed.
• Compiles and maintains clear, accurate, on-line documentation of all activity relating to billing and follow up efforts for each account, utilizing established guidelines.
• Responsible to read and understand all Advocate Aurora Health policies and departmental collections policies and procedures.
• Demonstrate proficiency in proper use of the software systems employed by AAH.
• This position refers to the supervisor for approval or final disposition such as: recommendations regarding handling of observed unusual/unreasonable/inaccurate account information. Approval needed to write off balance’s according to corporate policy. Issues outside normal scope of activity and responsibility.

Minimum Education And Experience Required

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

Minimum Knowledge, Skills And Abilities (ksa)

• Must perform within the scope of departmental guidelines for productivity and quality standards.
• Works independently with limited supervision.
• Accountable and evaluated to organization behaviors of excellence.
• Basic keyboarding proficiency.
• Must be able to operate computer and software systems in use at Advocate Aurora Health.
• Able to operate a copy machine, facsimile machine, telephone/voicemail.
• Able to read, write, speak and understand English proficiently.
• Able 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, terminology (CPT, ICD-10, HCPC) and insurance/reimbursement practices.
• Able to communicate well with people to obtain basic information (via telephone or in person).