Transplant Billing Specialist

Primary Purpose 

To support moderately complex processes related to billing, coding, and reimbursement. Actively following up with insurance carriers on open insurance claims. Team Member must have an understanding of contractual relationships. Supports complete and timely revenue collection from patients, third party payers, via accurate entry and/or correction of patient, charges and insurance information into the system. Brings patterns/trends to coding and compliance, contracting and credentialing and leadership for any potential in delay/denial of reimbursement. Verifies daily electronic claim submission.

Major Responsibilities 

• Independently review accounts and apply billing follow up knowledge required for all insurance payors to insure 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 and 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 entity) 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 leaderships attention recoding and compliance, contracting, claim form edits/errors and credentialing for any potential in 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 patient accounting system. Appeals claims to assure contracted amount is 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, on-line documentation of all activity relating to billing and follow up efforts for each account, utilizing established guidelines.
• Responsible to read and understand all Advocate Aurora Health policies and departmental collections policies and procedures. Demonstrate proficiency in 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 balance’s according to corporate policy. Issues outside normal scope of activity and responsibility.

Minimum Job Requirements 

Education: High School Diploma or General Education Degree (GED) 

Certification / Registration / License 

Work Experience: Typically requires 1 year of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience. 

Knowledge / Skills / Abilities 

• Must perform within the scope of departmental guidelines for productivity and quality standards.
• Works independently with limited supervision.
• Accountable and evaluated to organization 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 explanation of benefits (EOB), operating instructions and procedure manuals.
• Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC) and insurance/reimbursement practices.
• Ability to communicate well with people to obtain basic information (via telephone or in person).