Billing Follow Up Rep I

Experience Insurance Payer Portal

Major Responsibilities:

• Responsible for the accurate timely submission of insurance claims and the collection of designated portion of the accounts receivable.
• Contacts appropriate party to ensure most efficient collection follow-up. Contacts may include, patient, insurance companies, employers, third party administrators, attorneys.
• Reconciliation of the patient account including validation of contractual allowances or other adjustments posted to the account. Reviews coordination of benefits related to account. Identifies when claim resubmission to the insurance is needed.
• Contacts guarantor by telephone at home or place of employment to request payment in full, set up monthly payment arrangements, or discuss financial assistance options. Understand and communicate the billing, collection, and financial assistance processes to patients as appropriate.
• Submit claims to payers correctly and in a timely manner, ensuring claims are accurate and include any needed attachments or data prior to claim submission.
• Compile information for referral of accounts for Charity or Liens.
• Identify claims requiring correction in the NEBO system and make appropriate and timely correction. If the insurance billing/collection associate can't correct the rejection, correctly routes deficient claims to appropriate party for correction prior to claim submission.
• Monitor and follow up on deficient/unsent claims. Escalate claims exceeding SLA (Service Level Agreement) or other unsent claims appropriately.
• Demonstrate and maintain proficiency in the requirements, policies, terms of participation/contracts of the payer(s) and federal/state regulations in order to maximize reimbursement while ensuring clean and accurate claim submission. Works with teams to identify payer trends and report back to facilitate resolution of issues and improve processes.
• Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and collection efforts for each account, utilizing established documentation guidelines.
• Supports efficient, accurate collection follow up of accounts using multiple systems, including but not limited to, Patient Accounting, collections system, imaging system, probate system, payer websites.
• Responsible for the correction of claim rejections and resubmission of rejected claims, and the resolution of all delinquent patient accounts, per guidelines, in order to secure payment.
• Demonstrate the ability to determine the reason(s) for claim rejections by maintaining a proficiency in understanding the UB04/837 requirements, payer requirements, eligibility and benefits and revenue cycle operations
• Identifies specific payer trends, reports trends to team, and works with teams to develop solutions to address negative trends, ie, delays in payments.
• Identify claims which were not accepted by the payer. Correctly identify the cause of the rejection. If correction can be made appropriately by the insurance billing/collection associate, correct and rebill claim. In cases where a correction cannot appropriately be made by the insurance billing/collection associate, identify the appropriate party for resolution and ensure that appropriate correction has been made to allow for claim resubmission.
• Determine the patient’s financial status and ability to pay. Establish monthly payment terms with patients according to department policies
• Identifies allowancing issues and makes referral for appropriate adjustments to accounts.
• Recommend and refer uncollectible accounts to management for possible placement with an outside collection agency.
• Utilize the patient accounting claims, worklist systems, adjunct software systems and other tools proficiently in order to review, retrieve and update information as needed.
• Demonstrate proficiency in the proper use of the software systems employed by the SRCO, including but not limited to Allegra, STAR, Cerner, NEBO, Artiva, and Healthware Systems.
• Demonstrate proficiency in the proper use of the hardware systems employed by the SRCO, including but not limited to phone systems, printers, and fax machines.
• Demonstrate proficiency in the payer requirements, regulations, and policies which govern the payer(s) for which the insurance billing/collection associate is responsible for billing.
• Work accounts on Artiva worklist according to established parameters. Document account activity in Artiva with concise and accurate notes related to billing per established documentation guidelines.
• Navigates web based functions and systems competently.
• Keeps abreast of all system requirement changes within the scope of the position.
• Other duties and responsibilities as assigned
• Responsible to read and understand all Advocate SRCO policies and departmental collections policies and procedures. 
• Maintains knowledge of HIPAA regulations within the scope of the position and carry out job duties in a manner consistent with these regulations ensuring action is taken within guidelines set forth.
• Must attend and participate in and understand information presented at department meetings.
• Directs all questions or needs for clarification to management to ensure training needs are readily identified and addressed.
• Identifies and makes recommendations for process improvements
• .Responsible to read and understand all correspondence from Government Regulatory Agencies, Payer Updates, etc.
• Keeps abreast of all system requirements and changes. Achieves proficiency in all applicable functions of the patient accounting systems.
• Assists in completing ad hoc projects and related job activities as assigned to support department operations.
• During periods of high volume and/or impending deadlines, assignments may include assisting with patient accounting activities and functions typically performed by other SRCO positions.

Responsible for personal and professional growth and development.

• Seeks assignments and special projects to facilitate growth towards potential advancement.
• Keeps abreast of current practices via literature, educational offerings, professional affiliations, etc. 
• Acquires and maintains knowledge of all insurance regulations, local, state, and federal legislation and regulatory agencies and activities which may affect SRCO operations.

Education/Experience Required:

•  High School Diploma or general education degree (GED) • 2-3 years of healthcare billing or collection experience (preferably in a hospital setting). • Familiarity with medical terminology. • Excellent working knowledge of electronic billing systems. • Working knowledge of the healthcare revenue cycle process. • Basic understanding of CPT4, HCPCS, modifiers, ICD-9CM • Clear understanding of HIPAA regulations.

Knowledge, Skills & Abilities Required:

• Typing 35 WPM • 10 key calculator • Must be able to operate computer and software systems in use at the SRCO. • Able to operate a copy machine, facsimile machine, telephone/voicemail. • Ability to read, write, speak and understand English proficiently.

Physical Requirements and Working Conditions:

• Strong interpersonal, communication and persuasion/negotiation skills required to effectively interact with internal & external parties.
• Must be able to follow detailed instructions.
• Ability to listen to and understand information and ideas presented verbally and in writing.
• Consistently exercises critical thinking skills or uses logic and reasoning to assess and resolve problems.
• Quickly makes sense of, combines and organizes information.
• Consistently maintains a professional and approachable demeanor.
• Able to work under pressure and meet stringent deadlines in a fast-paced environment.  Able to work independently
• Pays strong attention to details and maintains high degree of accuracy
• Successfully alternates between two or more activities or sources of information.
• Accepts responsibility and maintains high level of accountability
• Strong collaboration skills
• Available to respond to patient/third party requests during scheduled shift.
• Ability to work on a computer for extended periods of time
• Ability to speak on phone throughout a daily assigned shift (with opportunity to alternate between sitting and standing if necessary).
• Ability to work effectively in an open floor environment
• Lifting a minimum of 10 pounds

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. Incumbent may be required to perform other related duties.

Pay Range

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program