Revenue Cycle Insurance Spec

Responsibilities

• Triage invoices and determine appropriate action
• Maintain timely claims submissions and timely Appeals processes as defined by individual payors
• Resubmit insurance claims when necessary to the appropriate carrier based on each payor's specific process with the knowledge of timelines
• Research, respond and take necessary action to resolve inquiries from PSRs (Patient Service Reps), Cash Department, Charge Review and Refund Department requests
• Follow-up via professional emails to ensure timely resolution of issues
• Review, research and facilitate the correction of insurance denials, charge posting and payment posting errors
• Follow all Managed Care guidelines using the UFJPI Payor Claims Matrix and Managed Care Matrix for each contracted plan
• Identify and enter affected invoices on the MES (Monthly Escalation Spreadsheet) using Excel, ESM or separate spreadsheets that may be needed
• Inform Team Leader on the status of work and unresolved issues
• Alert Team Leader of backlogs or issues requiring immediate attention
• Identify trended denials and report to supervisor, export trended/unpaid invoices on Excel to track and provide to supervisor
• Perform special projects assigned by the Team Leader or Manager
• Verify completeness of registration information
• Add and/or update as needed
• Verify and/or assign insurance plan and code appropriately
• Verify and enter patient demographic information utilizing automated billing system
• Verify insurance coverage utilizing various online software tools
• Complete correspondence inquiries from payors, patients and/or clinics to provide the needed information for claims resolution
• Respond and send emails to all levels of management in the Revenue Cycle Departments, Cash Posting Department, Refunds Department, Managed Care, Referral Department, Clinics and the CDQ Department to resolve coding and billing issues
• Maintain timely communication to ensure all necessary action has been taken
• Documents notes in the automated billing system regarding patient inquiries, conversations with insurance companies, clinics, etc. for all actions
• Receive and make outbound calls, written or electronic communications, navigate multiple web portals and websites to insurance companies for status and resolution of outstanding claims
• Status appeals, reconsiderations and denials
• Make outbound calls to patients to obtain correct insurance information and demographics
• Review and interpret electronic remits and EOB's to work insurance denials to determine appropriate action needed
• Determine appropriate insurance adjustments and obtain adjustment approvals as outlined in the company policy
• Verify and/or assign key data elements for charge entry such as, location codes, provider #'s, authorization #'s, referring physician, CPT, ICD-10, etc.

Qualifications

• 5 years Health care experience in Medical Billing or related experience
• Proven ability to develop course work presentations
• Ability to apply adult learning methodology in training classes/presentations
• Experience with medical systems (preferred)
• Knowledge of CPT and ICD Coding and Medical terminology of most current versions (required)
• High School Diploma or GED equivalent (required)
• Bachelor’s Healthcare, Finance, IT or Education (preferred)
• Certified Professional Coder (CPC) required