GENERAL SUMMARY:
Responsible for meeting department accounts receivable (AR) metrics and guidelines regarding third party claims submission, follow up on unpaid claims/inaccurate payments and appealing claim denials. Utilizes analytical and problem resolution skills to enhance workflows and maximize reimbursement. Builds and fosters positive relationships with all Bryan Health entities, third party representatives and external resources that will contribute to completing the revenue cycle on all third party billed professional services.
PRINCIPAL JOB FUNCTIONS:
1. Commits to the mission, vision, beliefs and consistently demonstrates our core values.
2. Analyzes, researches and prepares third party claims (including required attachments) timely, completely and accurately guaranteeing maximum reimbursement for billed professional services within a minimum timeframe.
3. Responds to all inquiries, denials of professional services and other correspondence and phone requests in an efficient and effective manner.
4. Performs follow up inquiries via telephone, secure third party portals or secure email f0r outstanding/unpaid claims according to department guidelines; involving the patient as necessary while maintaining professionalism.
5. Resolves problem accounts independently using sound judgement and following established departmental guidelines in a timely manner while meeting established productivity goals with appropriate escalation to payer representatives.
6. Analyzes financial metrics relating to AR/unpaid claims/etc. and addresses trends and barriers negatively affecting the revenue cycle of Bryan Heart with reporting of items to direct report supervisor/director.
7. Assists with monitoring payer denial trends and development of denials management process.
8. Regularly advises direct report supervisor/director of concerns related to payer performance, system functionality and any other identifiable barriers to performance thus negatively influencing the organizational goals and metrics.
9. Documents clear, concise, complete and accurate notes in the patient account regarding claim status.
10. Responds to directives and assignments in a timely manner while conveying professionalism and cooperation during interactions with co-workers, third party representatives, patients and the like.
11. Achieves and consistently maintains departmental productivity goals and metrics.
12. Actively participates in meetings to build a cohesive team by responding to inquiries, making recommendations, sharing observations and respecting other team member's input.
13. Maintains all documentation (EOB's-payer correspondence-forms necessary to position) in a consistent, properly titled format and accessible location for team members to access when necessary.
14. Develops and fosters relationships with outside provider offices/facilities and across Bryan Health entities enhancing the account resolution process.
15. Participates and completes mandatory annual training as assigned by Bryan Heart/Bryan Health.
16. Maintains professional growth and development through seminars, workshops, and professional affiliations to keep abreast of latest trends in field of expertise.
17. Participates in meetings, committees and department projects as assigned.
18. Performs other related projects and duties as assigned.
(Essential Job functions are marked with an asterisk "*". Refer to the Job Description Guide for the definition of essential and non-essential job functions.) Attach Addendum for positions with slightly different roles or work-specific differences as needed.
REQUIRED KNOWLEDGE, SKILLS AND ABILITIES:
1. Knowledge of Federal, State and commercial insurance (third party payers) billing guidelines.
2. Knowledge of basic American Medical Association's Current Procedural Terminology manual (CPT) and International Classification of Diseases Manual (ICD-10) with understanding how they link to one another.
3. Knowledge of computer hardware equipment and software applications relevant to work functions.
4. Knowledge of Federal, State and commercial remittance advices in detail including remittance/remark codes.
5. Knowledge of correct grammar, spelling and punctuation to facilitate typing information.
6. Skill in operating a computer, photocopier and fax machine.
7. Ability to communicate effectively both verbally and in writing.
8. Ability to establish and maintain effective working relationships with all levels of personnel and medical staff.
9. Ability to problem solve and engage independent critical thinking skills.
10. Ability to maintain confidentiality relevant to sensitive information.
11. Ability to prioritize work demands and work with minimal supervision.
12. Ability to maintain regular and punctual attendance.
EDUCATION AND EXPERIENCE:
High school diploma or general education degree (GED). Minimum of one (1) year experience in medical billing and insurance follow up or working with insurance in medial office/hospital revenue cycle/billing office required. Medical coding process understanding/background preferred.