- Monitor and resolve claims holding on discharged not final billed (DNFB) list.
- Ensure all claims are filed electronically except for some paper claims.
- Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership.
- Follow up on unpaid Medicaid and Managed Medicaid claims in a timely manner.
- High dollar accounts will have consistent follow up until the account has been resolved.
- Responsible for reviewing and understanding explanation of benefits/remittance advice.
- Ensure statements are generated for the patient responsibility amounts.
- Utilize insurance websites to view and resolve claims.
- Perform extensive account follow-up and provide analysis of problem accounts.
- Document all follow up efforts in a clear and concise manner into the AR system.
- Familiar with inpatient only procedure list and work with Revenue Cycle leadership to prevent denials
- Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account
- Ensure medical record requests are documented and submitted in a timely manner
- Identify and report all trends that may provide insight into payment challenges.
- Phone contact with patient, physician office, attorney, etc for additional information to process claims.
- Work assigned accounts as directed while reaching daily productivity goals.
- Complete tasks by deadline.
- Attend seminars as requested.
- Other duties as assigned.
MINIMUM EDUCATION & EXPERIENCE
- High School Diploma, or GED
- 1 year of patient registration, billing or equivalent experience
- Working knowledge of medical and insurance terms is desirable.
KNOWLEDGE, SKILLS, & ABILITIES
- Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies.
- Knowledge of general insurance requirements.
- Experience working directly with EOBs and contractual adjustments.
- General computer knowledge, working with electronic filing.
- Ability to communicate verbally/in writing with professionalism.
- Ability to meet productivity expectations.