Advocate Health · 7 hours ago

Billing Follow Up Rep I (remote Medicare HMO)

Milwaukee, WI

Full-time

Remote

Entry Level

1+ years exp

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Responsibilities

Independently review accounts and apply billing follow up knowledge required for all insurance payors to insure proper and maximum reimbursement. Uses multiple systems to resolve outstanding claims according to compliance guidelines.

Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge (ie;CPT,ICD-10 and HCPCS, NDC, revenue codes and medical terminology).Will obtain necessary documentation from various resources.

Ability to timely and accurately communicate with internal teams and external customers (ie; third party payors, auditors, other entity) and acts as a liaison with external third party representatives to validate and correct information.

Comprehends incoming insurance correspondence and responds appropriately. Identifies and brings patterns/trends to leaderships attention re:coding and compliance, contracting, claim form edits/errors and credentialing for any potential in delay/denial of reimbursement. Obtains and keeps abreast with insurance payer updates/changes, single case agreements and assists management with recommendations for implementation of any edits/alerts.

Accurately enters and/or updates patient/insurance information into patient accounting system. Appeals claims to assure contracted amount is received from third party payors.

Complies and maintains KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines.

Compile information for referral of accounts to internal/external partners as needed. Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and follow up efforts for each account, utilizing established guidelines.

Responsible to read and understand all Advocate Aurora Health policies and departmental collections policies and procedures. Demonstrate proficiency in proper use of the software systems employed by AAH.

This position refers to the supervisor for approval or final disposition such as: recommendations regarding handling of observed unusual/unreasonable/inaccurate account information. Approval needed to write off balance’s according to corporate policy. Issues outside normal scope of activity and responsibility.

Qualification

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Billing follow up knowledgeRevenue cycle knowledgeMedical terminologyCPT codingICD-10 codingHCPCS codingNDC knowledgeInsurance reimbursement practicesBasic keyboarding proficiencyEnglish proficiency