Accounts Receivable Medical Billing

Brief Description

Medical Billing AR & Denial Follow-Up Specialist

Summary

The Medical Billing AR & Denial Follow-up Specialist is primarily responsible for analyzing and resolving all insurance claim denials across a broad spectrum of Behavioral Health and Substance Use Disorder programs at BHN.

The Medical Billing AR & Denial Follow-up Specialist follows up on all claims not paid after 45 days of submission and documents their findings in BHN’s EHR system. In addition, the Medical Billing AR & Denial Follow-up Specialist will be expected to generate effective written appeals to carriers using well-researched logic to recoup reimbursement on incorrectly denied and underpaid claims.

ESSENTIAL JOB FUNCTIONS*

• Follows up on all assigned claims (45 days, 60 days, and 90 days) to ensure timely reimbursement and bring claims to closure.
• Reviews denied claims for accuracy to ensure coding, billing rates, and modifiers are accurate before sending appeals or reconsiderations to payers.
• Investigates claims with no payer response to ensure the payer received the claim.
• Navigates payer websites and appeal processes as defined by all payers including commercial and government payers including Mass Health, Tricare, Medicare, Medicaid, and Medicare Advantage plans.
• Reviews and finds trends or patterns of denials to prevent errors.
• Assists and confers with the EHR Matrix team and Billing Manager concerning any coding or modifier setup issues.
• Responsible for identifying missing payments, overpayments, and analyzing credits on accounts. Initiates refund requests for credit and overpayments.
• Delivers timely required reports to the management team, initiates and communicates the resolution of issues, such as payer denial trends due to coding and billing errors.
• Supports and participates in process and quality improvement initiatives.
• Provides exceptional customer service; answering individual served and insurance calls; promptly returns and follows-up on all interactions; promptly responses to requests for information, both internally and externally.
• Proactively resolves issues and provides timely response to questions and concerns.
• Documents issues and resolutions.
• Successfully tracks and follows up on information requests and provides timely resolution for assigned programs or payers.
• Promptly appeals carrier denials through coding review, contract review, medical record review, and carrier interaction.
  
  
  

Other Duties And Responsibilities

• Demonstrates a high level of expertise in the management of denied claims and deploys an analytical approach to resolving denials through the recognition of trends and patterns.
• Proactively recognizes and resolves recurring issues.
• Communicates identified denial patterns to management.
• Prioritizes follow-ups and process denials while maintaining a high quality of work.
• Serves as an escalation point for unresolved denial issues.
• Informs team members of payer policy changes.
• Strives for accuracy in all transactions, processes, and compliance requirements.
• Demonstrates knowledge of behavior health and substance abuse CPT codes, modifiers, and medical terminology to effectively determine if an appeal is warranted.
• Assists in educating team members and other BHN employees, when needed. Collaborates on special projects.
• Other duties as assigned.
  
  
  

Preparation, Knowledge, Skills & Abilities

• High School Diploma or GED required.
• Minimum of 5 years of experience in a medical billing department with strong AR account follow-up, appeals, and Behavioral Health codes and modifier knowledge required.
• Demonstrated knowledge of and experience in healthcare medical billing, claims processing, follow-up, and appeals required.
• CPC certification is preferred but not required.
• Carelogic EHR with working knowledge and experience is a strong preference but not required.
• Must be a critical thinker with strong research, analytical, and mathematical skills required.
• Current knowledge of HIPAA compliance, 42 CFR requirements, and changing regulatory guidelines.
• Extensive comprehension in utilizing email, search engines, and the Internet with the ability to effectively use payer websites.
• Active understanding and use of Microsoft Products: Outlook, Word, and Excel.
• Ability to work independently, flexibly shifting from big picture to detailed tasks, with high productivity, and regularly executing deadlines.
  
  
  

If you are interested in this opportunity, please click 'Apply for Job' below or visit our website at www.bhnworks.org and click on “Browse All Jobs” to apply!

BHN maintains its commitment to social justice and diversity and strongly encourages diverse candidates to apply.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.