Billing Follow Up Representative I

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.
• Obtains and keeps abreast with insurance payer updates/changes, single case agreements and assists management with recommendations for implementation of any edits/alerts.
• 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.
• Compile information for referral