Northwestern Medicine Central DuPage Hospital · 2 months ago
Professional Billing Denials and Follow Up Representative
Warrenville, IL
Full-time
Onsite
Entry Level
1+ years expNorthwestern Medicine Central DuPage Hospital is committed to delivering world-class care and is seeking a Professional Billing Denials and Follow Up Representative. This role involves timely resolution of claim edits, follow-up on third-party payer receivables, and compliance with relevant policies and regulations to ensure accurate billing processes.
Hospital & Health Care
Responsibilities
Consistently meet the current productivity and quality standards in timely resolution of all claim edits, reporting of candidates for bill, outbound compliant claim submission, clinical documentation requirements and any other communication required (verbal or written) regarding claims ensuring timely filing of claims and clean, complete and accurate claims
Consistently meet or exceed productivity standards, targets, error ratios, and reporting requirements assigned by the Patient Accounting Lead Financial Assessor and Operations Coordinator
Timely follow-up and collection of third party payer receivables. Denials and Appeals follow-up including root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution
Compliant follow-up correspondence to third party payers regarding outstanding accounts receivables (i.e. Statements, letters, e-mails, faxes, portal mail, etc.)
Support the operations related to optimum third party accounts receivables (i.e. Managed Care, Commercial, Medicare, Medicaid, Replacement plans, Workers Compensations, Corporate Accounts, Research, and Specialty AR Accounts)
Perform daily, systematic reviews of work lists to ensure all accounts already to be worked are completed
Utilize Government, Commercial, and regulatory guidelines for collection of outstanding accounts. Recommend accounts for contractual or administrative write-off and provide appropriate justification and documentation
Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices. Provide individual contribution to the overall team effort of achieving the department accounts receivable goals
Identify opportunities for customer, system and process improvement and submit to management
Follow the NMHC general Policy and Procedures, the Departmental Policy and Procedures, and any Emergency Preparedness Procedures. Follow Joint Commission and outside regulatory agencies mandated rules and procedures
Utilize assigned menus and pathways in the hospital mainframe system and report software application problems to the appropriate supervisor
Utilize assigned menus and pathways in external software applications and report software application problems to the appropriate supervisor
Utilize assigned computer hardware and report hardware problems to the appropriate supervisor
Participate in the testing for assigned software applications, including verification of field integrity
Assist the Patient Accounting Operational Coordinator and Patient Accounting Team Lead Financial Assessor with special projects and other duties as assigned, as necessary
Attend training and seminars as assigned and approved by the Patient Accounting Operations Coordinator
Demonstrate excellent customer service through oral and written communication in providing assistance/expertise to patients, authorized guarantors, and other external and internal contacts
Demonstrate proficient use of systems and execution of processes in all areas of responsibilities
Working knowledge of physician and facility billing and follow-up including understanding of insurance rules and regulations especially Medicare and Medicaid. Knowledge of HIPAA standards
Ability to perform mathematical calculations
Excellent communication skills when dealing with patients, families, public, co-workers, and professional offices. Basic knowledge of medical terminology and billing practices
Qualification
Required
High School diploma
One year related work experience or college degree
Ability to perform mathematical calculations
Basic knowledge of medical terminology and billing practices
Extensive experience and knowledge of PC applications, including Microsoft Office and Excel
Learn quickly and meet continuous timelines
Exhibit behaviors consistent with principles of excellent service
Preferred
Two or more years' college or college degree
Call center, telephone work experience or cash collections experience
Knowledge of Epic Systems
Two (2) years progressive work experience in a hospital/ physician billing or SBO environment
Detail-oriented, good organizational skills, and ability to be self-directed
Strong time management skills, managing multiple priorities and a heavy workload in a high-stress atmosphere
Flexibility to perform other tasks as needed in an active work environment with changing work needs
High-level problem solving, analytical, and investigational skills
Excellent internal/external customer service skills
Benefits
$10,000 Tuition Reimbursement per year ($5,700 part-time)
$10,000 Student Loan Repayment ($5,000 part-time)
$1,000 Professional Development per year ($500 part-time)
$250 Wellbeing Fund per year ($125 for part-time)
Matching 401(k)
Excellent medical, dental and vision coverage
Life insurance
Annual Employee Salary Increase and Incentive Bonus
Paid time off and Holiday pay
Company
Northwestern Medicine Central DuPage Hospital
Central DuPage Hospital is part of Northwestern Medicine.
5001-10000 employees
Funding
Current Stage
Late StageLeadership Team
Claudia Mahoney
Associate Chief Nursing Officer
Jessica Arendarczyk
Project Partner
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