Overview

Job Summary:

Demonstrates through behavior Decatur Morgan Hospital’s mission, vision and values. Billing Insurance Follow Up Specialist is responsible to submit claims timely and accurately to insurance and governmental payers. To monitor their assigned payers and follow up on unpaid claims or claims identified within the at-risk claims work queue. To promptly resolve and resubmit those claims back to their assigned payers. The IBF Specialist is responsible for processing and posting payments both electronically and manually, applying appropriate contractual adjustments and working payer denial. Provides customer service by taking patient calls and answers billing questions, takes phone payments and is able to setup payment plans on outstanding patient balances. The IBF Specialist will also work credit balances and process refunds both insurance and patient.

Responsibilities

Key Responsibilities / Essential Functions

1.     Processes and validates claims via electronic submission or other acceptable payer specific methods.

2.     Initiates follow up procedures on unpaid claims within defined timeline to ensure timely payment is received.

3.       Reviews various reports/work queues and identifies rejected or denied claims making appropriate corrections.

4.       Communicates repetitive or unusual errors to manager and/or others to resolve problematic actions or activities which may be user or system driven affecting clean claim accuracy.

5.       Utilizes Patient Management System applications appropriately as trained to gain maximum efficiency while billing and conducting follow up of patient accounts.

6.       Responds to payer requests for additional information timely in order to facilitate claim processing and payment.

7.       Reviews payer specific remittances to analyze and make corrections in order to re-bill/appeal or internally adjudicate claims in response to denials. Utilizes knowledge and experience to ensure appropriate reimbursement is obtained and appropriate adjustments are processed.

8.       Processes transaction adjustments as may be necessary as supported by remittance documentation. Processes payment posting timely electronic and manually as necessary.

9.       Applies notes to individual patient accounts that are informative, concise and facilitates corrected account resolution.

10.    Review and process credit balances as appropriate to insurance or guarantor.

11.    Answer patient calls and discuss patient balances. Take payments and set up appropriate payment plans.

Qualifications

Minimum Knowledge, Skills, Experience Required:

Education:  High School Diploma, GED required. Medical billing certification desirable

Experience: Minimum of one year working experience in professional/hospital insurance billing, collections and payment posting processes with a clear understanding of insurance reimbursement principles. Computer literacy with basic skills in patient account management systems, Microsoft Suite, particularly Excel and Word as well as various web-based applications.