Billing and Follow-Up representatives will be responsible for performing all billing and follow-up functions, including the investigation of payment delays, resulting from no response, denied, rejected and/or pending claims with the objective of appropriately maximizing reimbursements and ensuring that claims are paid in a timely manner. This position requires strong decision making ability around complex claims processing workflows and regulations that requires utilization of data coming from multiple resources. To evaluate billing and follow-up issues appropriately, Reps will need to have an understanding of the entire Revenue Cycle and be able to interact with Government and Commercial insurances
Billing and Follow Up Responsibilities
Resolve billing errors/edits, including accounts with Stop Bills and "DNBs" to ensure all claims are filed in a timely manner
Ensure all claims are accurately transmitted daily and all appropriate documentation is sent when required
Verify eligibility and claims status on unpaid claims
Review payment denials and discrepancies and take appropriate action to correct the accounts/claims.
Respond to customer service inquiries
Perform charge corrections when necessary to ensure services previously billed incorrectly are billed out correctly
Submit replacement, cancel and appeal claims to third party payers
Provide timely feedback to management of identified claims issues, repetitive errors, and payer trends to expedite claims adjudication.
Work accounts in assigned queues in accordance with departmental guidelines.
Contact patients for needed information so claims are processed /paid in a timely manner
Work directly with third party payers and internal/external customers toward effective claims resolution.
Basic UPH Performance Criteria
Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.
Demonstrates ability to meet business needs of department with regular, reliable attendance.
Employee maintains current licenses and/or certifications required for the position.
Practices and reflects knowledge of HIPAA, TJC, DNV, OSHA and other federal/state regulatory agencies guiding healthcare.
Completes all annual education and competency requirements within the calendar year.
Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.
10 key calculator skills required
Ability to type 30 WPM
Written and verbal communication
Basic computer skills
Planning and organizing skills