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Brown University Health · 1 day ago

PFS AR Insurance Follow-up

Providence, RI

Full-time

Hybrid

Entry Level

$19.97/hr - $32.96/hr

1+ years exp

Brown University Health is a healthcare organization seeking a PFS AR Insurance Follow-up professional. The role involves processing patient bills, ensuring timely reimbursement of third-party claims, and maintaining compliance with various regulations and guidelines.

EducationHealth CareMedicalUniversities

Responsibilities

Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system

Responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct

Review claim forms for all required data fields depending on the specific 3rd party requirements

Review patient account for demographic accuracy

Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data

Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer's contracts or Federal reimbursement methods

Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment

Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language

Continually maintains knowledge of payer specific updates via payer's listservs, provider updates, webinars, meetings and websites

Review payer's settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer's policies and each individual related contract

Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors

Understands and maintains compliance with HIPAA guidelines when handling patient information

Initiate adjustments to payer's as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials

Submits appeals to payers as appropriate to recover denied revenue

Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials

Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown

Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies

Answer telephone inquiries from 3rd parties and interdepartmental calls

Refer all unusual requests to supervisor

Retrieve appropriate medical records documentation based on third party requests

Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations

Process all incoming mail and follow up on all rejections received according to specific 3rd party regulations

Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures

Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department

Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates

Perform other related duties as required

Qualification

3rd party billingICD codingCPT codingHCPCS codingMedical collectionsProblem-solvingInductive reasoningCommunication skillsCritical thinkingRelationship-building

Required

Equivalent to a high school graduate

Knowledge of 3rd party billing to include ICD, CPT, HCPCS, UB and HCFA 1505 claim form

Demonstrated skills in critical thinking, diplomacy and relationship-building

Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings

Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies