MAJOR RESPONSIBILITIES Independently review accounts and apply billing follow-up knowledge required for all insurance payors to ensure 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 (i.e., CPT, ICD-10, 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 (i.e., third-party payors, auditors, other entities) 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 leadership's attention regarding coding and compliance, contracting, claim form edits/errors, and credentialing for any potential 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 the patient accounting system. Appeals claims to assure contracted amounts are 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 of accounts to internal/external partners as needed. Compile and maintain clear, accurate, online documentation of all activity relating to billing and follow-up efforts for each account, utilizing established guidelines.Responsible for reading and understanding all Advocate Aurora Health policies and departmental collections policies and procedures. Demonstrates proficiency in the proper use of the software systems employed by AAH.This position refers to the supervisor for approval or final disposition such as recommendations regarding handling of observed unusual/unreasonable/inaccurate account information. Approval needed to write off balances according to corporate policy. Issues outside normal scope of activity and responsibility.MINIMUM EDUCATION AND EXPERIENCE REQUIRED Years of Experience: Typically requires 1 year of related experience in a medical/billing reimbursement environment, or equivalent combination of education and experience.Level of Education: High School Diploma or General Education Degree (GED)MINIMUM KNOWLEDGE, SKILLS AND ABILITIES (KSA) Must perform within the scope of departmental guidelines for productivity and quality standards.Works independently with limited supervision.Accountable and evaluated to organizational behaviors of excellence.Basic keyboarding proficiency.Must be able to operate computer and software systems in use at Advocate Aurora Health.Able to operate a copy machine, facsimile machine, telephone/voicemail.Ability to read, write, speak, and understand English proficiently.Ability to read and interpret documents such as explanations of benefits (EOB), operating instructions, and procedure manuals.Preferred but not required knowledge of medical terminology, coding terminology (CPT, ICD-10, HCPCS), and insurance/reimbursement practices.Ability to communicate well with people to obtain basic information (via telephone or in person).This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the incumbent. The incumbent may be required to perform other related duties.
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