Insurance Billing & Follow Up Specialist

Job Summary:

Under the direction of the Manager - Billing and AR Follow-up, performs the insurance billing and follow up with third party payers to resolve outstanding claims, including but not limited to claim status, rebilling, submitting claims for reconsideration, claim appeals, and recommendations for account adjustment as appropriate. Provides daily operational support for problem/issue resolution and daily oversight of designated teams. Exhibits the F.I.R.S.T. values (Friendliness, Innovation, Respect, Service, and Trust).

Essential Functions, Duties, And Responsibilities:

1. Performs all initial billing for all payers via paper and electronic claims submissions.
2. Reviews all billing claims for accuracy of charges and appropriate billing edits.
3. Maintains a working knowledge of billing requirements for all payers and makes the needed corrections to the claims prior to billing.
4. Demonstrates the ability to maneuver around the websites associated with your designated payer to check eligibility and claim status and stays current with any ongoing changes.
5. Performs timely follow up on all outstanding balances due from the insurance companies by working daily AR reports.
6. Reviews all credit balances that are due back to the insurance payers and able to process them appropriately.
7. Completes a daily productivity of follow up accounts worked from the AR maintaining an 85% monthly average.
8. Meet and maintain quality standards established by the department. 
9. Reviews patient registration information for accuracy.
10. Performs timely follow up to all Payer Rejections that come thru the Clearinghouse from your designated payer.
11. Review all claim denials and remittance rejections for accuracy of charges and appropriate billing edits. You are able to have the corrections made and charges re-filed to the insurance company or able to determine if the balance is self-pay or a contractual adjustment.
12. Being courteous and respectful at all times to patients and associates throughout the organization by demonstrating the F.I.R.S.T. Values at all times.
13. Demonstrates a commitment to professional accountability and growth to maintain and expand knowledge and skills.
14. Contributes to the achievement of the mission and philosophy of the Organization.
15. Contributes to the effective operations of the Organization by demonstrating dependability in job performance.
16. Demonstrates a commitment to incorporating the core concepts of patient family centered care into practice (dignity, respect, information sharing, and participation).
17. Demonstrates a commitment to the development and implementation of shared governance across the Organization.
18. Evaluate and triage team questions and issues as they arise in regards to billing. 
19. Determine root cause of issues and recommend solutions for resolution. 
20. Escalate issues when appropriate including; but not limited to, denial trends, reimbursement issues/trends, payer mapping configurations, provider enrollment issues, and claims processing issues. 
21. Facilitate Education and Training for assigned team members. 
22. Complete Quality reviews and productivity analysis for leadership review.  
23. Participate in testing of new systems and upgrades to organization systems.
24. Performs other related duties as assigned.

WORKING CONDITIONS, HAZARDS AND PHYSICAL EFFORT:

Average work station area with normal levels of noise. Minimal physical exertion. Must be able to work with constant interruptions. The task of this job does not involve exposure to blood, body fluids, or tissue. Must be able to move or position 25 lbs. independently.

Contacts With Others:

Contact with most all Ephraim McDowell Health Associates, patients, visitors, insurance carriers, physicians' offices staff and collection agencies.

Equipment Used/Special Skills Required:

Standard office equipment, Microsoft Office and G-Suite. Excellent communication skills. In-depth knowledge of third-party payer benefits required.

Qualifications

Two (2) years of experience in A/R follow-up, insurance billing, or related healthcare billing services OR Associates degree and One (1) year of relevant experience OR Four (4) year degree in healthcare or business-related field.