Recover lost revenue for the company related to underpayments. Review accounts billed to managed care networks to ensure proper payments are received for services provided.
Review work list to continue pursuit of underpayments verbally, electronically, or in paper format. Will provide feedback as opportunities for improvement are identified.
Essential Duties and Responsibilities
Reviews accounts appealed to managed care companies to recover lost revenue
Contacts appropriate managed care organizations to ensure expeditious processing of underpayment appeals
Where appropriate, aggregates underpayment trends for expedited processing
Manages assigned work list of underpaid accounts by utilizing work flow tools
Provides feedback to manager regarding false positive and true underpayment issues
Maintains a high level of accuracy of follow-up while maintaining thorough and concise notes documenting communication with managed care companies
Updates reason for pursuit and pursued amounts to accurately reflect current information
Carries accounts through completion
Assigns the appropriate reason for account closure
Updates fee schedules in patient management system
Identifies additional reimbursement posted to accounts in billed statuses
Reviews accuracy of additional payments posted to accounts prior to submitting for invoicing
Utilizes payer portal websites, client patient account systems, internal technology to continually validate activity, payment accuracy, and account status
Other Duties and Responsibilities
Other duties and responsibilities as assigned.
Familiar with ICD-9, CPT Coding, revenue codes, UB and HCFA billing formats. Knowledge/experience working with provider billing. Experience reviewing and appealing managed care underpayments
Two year degree or equivalent combination of education and experience.
Physical Demands/Work Environment (optional)
Occasionally required to move around the work area; sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; Must occasionally lift 15 pounds. Office environment. Sitting and keyboarding for extended periods of time. High attention to detail and ability to focus. Moderate noise level.
American Family Care, Inc.