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Billing & follow-up representative

Company Name:
Presence Health
ESSENTIAL DUTIES AND RESPONSIBILITIES 1. Ensure all claims are accurately transmitted daily within the CBO targets and goals. 2. Provide feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission. 3. Complete follow-up of claims on a timely basis according to the CBO productivity guidelines for account follow-up goals. 4. Review system generated work list, reports and/or aged trial balances to resolve accounts which have not been paid in the appropriate time frame, based on specific third party payor contracts and guidelines. 5. Contact the assigned payor representatives to determine when payment will be made and if any other information is required to adjudicate the claim. 6. Review payment denials and discrepancies identified through EOB, Remittance Advices or Payor correspondence and take appropriate action to correct these accounts. 7. Document account activity in an accurate and timely manner on all patient accounts. 8. Apply high level of knowledge of respective insurance billing regulations and guidelines. Research these guidelines when required on the payer websites where available. 9. Ensure compliance with all state and federal billing regulations and report suspected compliance issues to their respective Manager/Supervisor or Compliance Manager. 10. Conduct inquiries via telephone, mail, and fax or electronically through payer website or e-mail for follow-up of those unresolved accounts. 11. Contact patient for additional information in order to have claims processed and paid. 12. Work with various departments throughout Provena Health in obtaining additional information for the billing and follow-up process. 13. Work with Management and CBO staff to improve processes, increase accuracy, create efficiencies and achieve overall goals of the department. 14. Maintain proficiency and level of knowledge with all systems required for task completion. 15. Attend required training and complete on-line training and surveys as required. 16. Attend meetings with payor representatives and/or vendors to address outstanding issues and learn about new regulations and guidelines. This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. Other duties may be assigned. SUPERVISORY RESPONSIBILITIES Does Not Supervise Employees Directly supervises employee(s). Carries out supervisory responsibilities in accordance with the organization''s policies and applicable laws. Responsibilities include interviewing, hiring, and training employees; planning, assigning, and directing work; appraising performance; rewarding and disciplining employees; addressing complaints and resolving problems. QUALIFICATIONS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience High School diploma or equivalent. Minimum of 4 years in patient accounting/business office environment, specifically billing and/or collections in the assigned insurance area. Able to communicate clearly and professionally and have excellent interpersonal, verbal communication skills. Experience with computers, adding machine and normal office equipment (telephone, fax, copier, voice mail, etc.) Computer Skills Microsoft Office and Meditech patient accounting system experience preferred. Experience Hospital Illinois Medicaid Billing and collection follow up. Meditech Hospital Billing and eCare claim submission software. EOE of Minorities/Females/Vets/Disability

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