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Billing and Reimbursement Representative P

Position Summary
- Under general supervision, performs various billing office functions including insurance follow-up, denial follow-up, resolution of contact variances, and ensures all actions of the billing responsibilities are performed accurately and efficiently to support patient satisfaction and financial stability of the organization.
Position Responsibilities
- Unit Specific Position Responsibilities
  - Routinely monitors and manages insurance workqueues associated with insurance follow-up on primary, secondary, and subsequent payors. Reviews and works with insurance companies to resolve unpaid facility and professional claims to ensure prompt payment.
  - Analyzes and investigates all insurance denials. Performs a thorough, complex review of accounts including, but not limited to, authorization, charges, coding, and medical records to write an effective appeal to achieve a timely resolution.
  - Tracks denial patterns for trends, specific payor issues, and root causes. Advises management and provides suggestions to improve processes to prevent future denials.
  - Investigates and interprets payment variances. Reviews posting and explanation of benefits for payment, contractual adjustments, and patient responsibility.
  - Ensures reimbursement is in accordance with contracts, insurance plan benefits, and medical policies. Posts manual adjustments or submits reconsiderations and appeals as necessary for effective resolution and accurate reimbursement.
  - Evaluates and investigates third party refund requests. Appeals or processes refund requests as appropriate.
  - Initiates phone calls, utilizes website tools, and composes correspondence to engage with third party payors to rectify any payment concerns, discrepancies, or issues. Corrects and resubmits claims to payors as appropriate.
  - Processes information from all sources to make decisions within scope of job functions with minimal supervision while demonstrating a high level of professionalism.
  - Researches and updates account insurance coverages. Contacts patients by phone or letter for additional insurance information as needed.
  - Accurately and thoroughly documents all pertinent conversations, correspondence, actions, and activities performed on accounts to ensure progress is made.
  - Independently prioritizes and organizes work to ensure effective and efficient completion.
  - Work collaboratively with the Reimbursement Coordinator, Denials Coordinator, Health Information Management, Patient Access, and other departments as needed.
  - Assists in establishing and maintaining policies and procedures for billing and reimbursement activities to maintain quality assurance, optimal processes, and meet regulatory requirements.
  - Reports any observed or suspected deviation from medical center policies or from Medicare, Medicaid, or other insurance regulations immediately to the department Manager, Director, or the medical center’s Compliance Officer.
  - Displays responsiveness and flexibility to adapt to changes in work environment and modify approaches or methods to best fit the situation.
  - Demonstrates effective interpersonal skills to work with others to resolve account issues and ensure a high degree of customer satisfaction.
  - Participates in staffing meetings, staff development, and training
  - Performs other duties, responsibilities, and special projects as assigned.
Qualifications, Knowledge & Experience
- Required Qualifications (Including any licensure, certification, education):
  - Two years of higher education and/or two years of progressively responsible work experience in a medical office or insurance company setting.
  - Equivalent combination of education and experience that would demonstrate the capability to perform the duties of the position.
- Organizational Requirements:
  - Maintain stroke education per regulatory requirements.
- Preferred Qualifications:
  - AAHAM Certified Revenue Cycle Specialist
- Required Knowledge, Skills & Experience:
  - Internet usage skill
  - Knowledge of Microsoft related programs such as Word, Excel and Outlook
  - Excellent customer service skills
  - Detail orientated
  - Ability to analyze and interpret information to make decisions within scope of job functions with minimal supervision.
  - Effective oral and written communication skills with the ability to clearly and concisely articulate issues
  - Ability to multitask while maintaining accuracy in a fast-paced environment
- Preferred Knowledge, Skills & Experience:
  - Considerable knowledge of billing claim forms.
  - Considerable knowledge of the Federal and State regulatory requirements for billing accounts receivable.
  - Considerable knowledge of Medicare, Medicaid, and/or insurance carrier billing and reimbursement
  - Understanding of medical terminology and diagnosis and procedure coding
  - System experience – Epic, Medicare RTP, OnBase, Experian

Billing and Reimbursement Representative P

Billing and Reimbursement Representative P in Ames, Iowa at Mary Greeley Medical Center

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