Professional Billing & Insurance Follow-up Specialist

Remote Position (OR/WA Only)This is a remote position – incumbents, who reside in Oregon or Washington only. There may be occasional situations that require work to be performed on-site at an assigned Legacy Health location. All new hires are required to come to a designated Legacy Health office location in Portland, Oregon prior to their start date for a new hire health assessment and to complete new hire paperwork. This position may require initial training and orientation to be site-based, before transitioning to the remote schedule.ResponsibilitiesAre you ready to bring your clerical acumen to a health care community that values your work and recognizes it as vital to an overall mission of making life better for others? In addition to your advanced knowledge of multi-payer system and specialty billing procedures and contracts, we’ll rely on you to research incomplete bills, interpret codes and resolve patient complaints. Your desire to communicate with professionalism and patience will reflect the compassionate nature we strive to create throughout the Legacy community.Edits bills to ensure accuracy and completeness, applying knowledge and understanding of Universal Billing rules, regulations and claim form requirements.RequirementsReviews and completes necessary forms to ensure accurate billing. Specialty contracts and high dollar accounts may require many extra claim forms, knowledge of special requirements, adjustments, and matrix reviews to pay physicians:Works closely with payors for pre-pricing of high dollar claims to expedite claims processing.Performs high dollar medical record coding follow-up, contacting HIS to reduce coding delays.Checks patient demographic and insurance information. May be required to verify insurance for some claims:Performs verification when billing high dollar accounts.May check for lifetime reserve days.Combines inpatient overlap accounts, ancillary outpatient services within 72 hours of an inpatient admit.Re-assigns claims held in editor to ensure re-routing to appropriate biller.Follows up for missing information or diagnosis codes.Ensures proper physician names and provider numbers are listed.Documents billing history and data for A/R Management.Submits claims electronically and files hard copy claims as appropriate.Determines what supporting documents (e.g., Medical Records, Explanations of Benefits, Itemized Bill, TAR forms) should be included with claims and obtains if needed.Reviews and completes Claim Edits/Daily Unbilled report, taking appropriate action on each claim to reduce billing delays and produce a bill.Faxes claims to expedite higher volume of payer reimbursement.Rebills upon request after reviewing account notes and determining action to be taken.Initiates interim bills, complex in-house claims requiring transaction tracking and involvement in E-chart and/or Cerner Millennium.May review/resolve accounts with payment discrepancies for Medicare/Medicaid or secondary carriers.May determine whether “split” bill is required and request proper billing.May initiate paper adjustments and/or authorizations for agencies requiring special forms.Understands and applies the proper procedures for writing off adjustments s/he is authorized to make.May process flag reports ensuring timely verification, rebill, and/or adjustment of claims based upon payer response.Provides accurate Customer Service to internal and external customers regarding account status and pending actions.Contacts patients’ families, sometimes in sensitive situations, to resolve billing issues.Works closely with specialty contract liaisons: hospital attorneys, ASI – collection agency, crime victims, state agencies, Physician offices and/or corporate contracting to ensure proper billing.Answers all incoming telephone calls, voice mails, e-mails, faxes or personal requests in a professional manner.Interviews customer and assists appropriately.Works closely with providers, patients, and members of other LHS departments.Sets deadlines for future action on accounts.Communicates with third party payers regarding current account status. Works towards quick resolution and payment of claims. Effectively applies knowledge of regulations and practices used in reimbursement specialty area such as Government, Commercial, Medicare, Medicaid, Workers Comp or Motor Vehicle Accident coverage.Reviews notes of prior action before calling third party payer for payment resolution.Calls third party payers to bring claims to payment as soon as possible and remove any barriers that may delay the processing of a claim.Investigates when claims are suspended, denied, or not expedited.In account notes, accurately documents action taken and status of claim.Sends data mailers to patients as appropriate.Effectively uses appropriate databases to obtain information needed to process claims.Understands and uses USSP system for accurate claims payment dates and amount of payment and patient balance for all Regence Blue Cross productsObtains benefits, eligibility, PCP information, and authorization information when necessary to resolve payment issues.Understands and uses MMIS Online system to determine OHP/Medicaid eligibility and to interpret when OHP is primary or secondary payer.Understands and uses internet-based payer systems to obtain eligibility authorization, and claim status information.Understands FSS – Eligibility, claim status, adjustment process.Reviews And Organizes Daily Follow-up And Other Critical Reports.Understands and adheres to follow-up Matrix (timeline) for areas of specialty, i.e., number of days until first follow-up, second follow-up, third, etc.Tracks and reports total number of accounts received weekly.Groups accounts by payer to minimize number of phone calls needed for follow-up process.High-dollar, back-logged and call-back accounts are considered priority.May be responsible for processing certain reports such as Month End, Flag, Daily Unbilled, PARS, Expected Reimbursement, Carrier Code 0414, Carrier Code XX50, or HCFA electronic reports.Tracks and reports total number of accounts received weekly.May be assigned to work A/R Reduction reports with responsible area.Works effectively with large amounts of data and detail. Generates or works from multiple reports which may vary according to payer specialty.Performs Other Duties As Required.May serve as Notary PublicMay serve as “backup” for other PBS positions.May process mail.Acts as key trainer to new departmental employees on team policies/proceduresMay be assigned additional duties by leadershipQualificationsEducation:High school diploma or equivalent.ExperienceOne year of healthcare clerical experience or applicable billing, credit/collections experience. Healthcare billing or credit/collections preferred. Education may be substituted for experience requirement.SkillsDemonstrated knowledge high dollar of billing/collection rules and regulations, and specialty billing procedures and contracts.Demonstrated attention to detail.Demonstrated knowledge of multi-payor systems.Knowledge of online systems for eligibility, status review of claims and entering claims manuallyNet typing of 40 wpm and PC based computer skills.Ten key proficiency.Knowledge of medical terminology.Ability to work efficiently with minimal supervision, exercising independent judgment within stated guidelines.Demonstrated effective interpersonal skills which promote cooperation and teamwork.Ability to withstand varying job pressures and organize/prioritize related job tasks.Demonstrated effective interpersonal skills which promote cooperation, teamwork, and respect.Excellent public relations skill and demonstrated ability to communicate in calm, businesslike manner.Ability to adapt to change.Demonstrated negotiating, problem-solving and decision-making skills.Legacy’s Values In ActionFollows guidelines set forth in Legacy’s Values in Action.Equal Opportunity Employer/Vet/DisabledPay RangeUSD $22.52 - USD $32.20 /Hr.