Billing Follow Up Rep II

About the Role

This position is responsible for daily claims submissions and follow-up activities within the revenue cycle. Candidates must reside in one of the following states: AK, AL, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, or WY.

Responsibilities

• Submit daily claims (electronic, PC applications, and hard copy) to appropriate parties.
• Act as a resource for teams on complex issues, facilitate problem resolution, and provide training.
• Participate in quality audit processes, productivity tracking, and special projects as assigned.
• Resolve outstanding claims using multiple systems while adhering to compliance guidelines.
• Perform pre-billing, billing, and follow-up 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) via phone or mail.
• Act as a liaison with external third-party payer representatives to validate and correct information, ensuring regulatory and contractual compliance.
• Comprehend incoming insurance correspondence and respond appropriately.
• Identify and escalate patterns/trends in coding, compliance, contracting, claim form edits/errors, and credentialing that may delay or deny reimbursement.
• Stay updated on insurance payer changes, single case agreements, and assist management with implementing edits/alerts.
• Accurately enter and update patient/insurance information in the patient accounting system.
• Appeal claims to ensure contracted amounts are received from third-party payors.
• Maintain KPIs for assigned payers within departmental and insurance guidelines.
• Compile information for referral of accounts to internal/external partners as needed.
• Maintain clear, accurate online documentation of all billing and collection activities per established guidelines.
• Read and understand Advocate Aurora Health policies and departmental collections procedures.
• Demonstrate proficiency in software systems used by AAH.
• Escalate unusual, unreasonable, or inaccurate account information to supervisors for approval or final disposition.
• Seek approval for balance write-offs according to corporate policy.
• Address issues outside the normal scope of responsibility.

Requirements

• High School Diploma or General Education Degree (GED).
• Typically requires 2 years of related experience in a medical/billing reimbursement environment, or an equivalent combination of education and experience.

Skills

• Basic keyboarding proficiency.
• Ability to operate computers and software systems used at Advocate Aurora Health.
• Proficiency with copy machines, facsimile machines, telephones, and voicemail.
• Ability to read, write, speak, and understand English proficiently.
• Ability to read and interpret documents such as Explanation of Benefits (EOB), operating instructions, and procedure manuals.
• Knowledge of medical terminology, coding (CPT, ICD-10, HCPC), and insurance/reimbursement practices.
• Ability to problem-solve complex billing, coding, and contract issues.
• Experience using Zoom, Microsoft Office, or other communication software for meetings.
• Strong understanding of department-specific policies and procedures.
• Strong analytical, organizational, communication (written and verbal), and interpersonal skills.