Connecticut Children's Medical Center CT , CT 06785
Posted 1 week ago
SUMMARY
The Billing Associate II is responsible for follow-up on accounts as assigned by the Assistant Manager, to ensure all claims have been appropriately billed within 30 days and brought to resolution within 60 days. Responsible for the analysis and follow-up of denied claims, file appeals when appropriate, process carrier inquiries (both written and oral) and initiate refunds when necessary.
Works under general supervision following established protocols and procedures. Maintains confidentiality of all information. Reports to Sr. Manager.
ROLE RESPONSIBILITIES
Reviews and maintains billing processes to establish timely cash collections with the payer
Analyzes accounts daily to ensure all claims are worked within 30 days and target goal, as set by Sr. Manager, is met
Audits delinquent and aging insurance claim reports, researches and reconciles outstanding accounts to resolve issues and determine if adjustment, correction, or rebilling should take place. Follows through with third party payers to resolve payment issues and ensure timely receipt of payments
Determines appropriate judgment on claims over 60 days old
Retrieves all medical documentation and initiates appeal process when appropriate
Determines when payer refund is necessary and initiates paperwork
Seeks ways and opportunities to increase productivity and efficiency, while maintaining or improving quality
Acts as a liaison between practices and the billing office to ensure timely resolution to inquiries
Identifies and directs, based on payer policy guidelines, all requests for write-offs to management for approval
Initiates contact with provider reps when appropriate to resolve difficult claim issues
Performs related duties as required in support of dept operations
Demonstrates knowledge of the population-specific differences and needs of patients in appropriate, specific populations from neonate through adolescence and applies them to practice.
Demonstrates cultural sensitivity in all interactions with patients/families and co-workers.
Demonstrates support for the mission, values and goals of the organization through behaviors that are consistent with the CCMC STANDARDS
EDUCATION and/or EXPERIENCE REQUIRED
Education Required: High School Diploma, GED, or a higher level of education that would require the completion of high school, is required
Experience Required: 3 years professional billing experience
LICENSE and/or CERTIFICATION REQUIRED
Certification in medical coding preferred
KNOWLEDGE, SKILLS AND ABILITIES REQUIRED
KNOWLEDGE OF
ICD-9, CPT, and medical terminology preferred
Basic knowledge of payer policies and claim billing
Basic knowledge of Microsoft Word, Excel
SKILLS
Must have excellent customer service skills
Excellent written and verbal communication skills
ABILITY TO
Prioritize multiple tasks to ensure all responsibilities of position are addressed in a timely manner
Connecticut Children's Medical Center