The Professional Billing Denials and Follow Up Representative reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
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.
Additional Responsibilities:
- 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