Requisition ID: 24402

Location: Primary Cardiology - Elgin

Location Address:
1975 Lin Lor Lane Suite 175, Elgin, IL 60123 United States (US)

Daily Hours: 8
Standard Hours: 40
Employment Status: Full-time
Employment Type: Regular
Shift: Day
FLSA: N

Billing & Follow-Up Rep II

This position is at 1975 Lin Lor Lane, Elgin, IL 60123

The Billing and Follow-Up Representative II performs accurate, timely and compliant billing and follow-up of assigned accounts. Ensures proper submission and adjudication of all claims submitted to third party carriers and intermediaries. They are responsible for providing a timely response to all inquiries in accordance with the policies and procedures of the Presence Health Central Business Office (CBO).

Duties & Responsibilities

Ensures all claims are accurately transmitted daily within the CBO targets and goals.

Completes follow-up of claims on a timely basis according to the CBO productivity guidelines for account follow-up goals. Pursues unpaid accounts by telephone or electronic inquiry to determine status of payment in accordance with department follow up timeliness.

Employs measures to expedite claim adjudication by resolving issues that may delay processing of payment. Involves the patient or guarantor when necessary.

Provides feedback to management regarding any issues or repetitive errors that may be encountered during claim review and submission. Documents account activity in an accurate and timely manner on all patient accounts.

Reviews system generated work lists, reports and/or aged trial balances to resolve unpaid accounts, based on specific third party payer contracts and guidelines.

Contacts the assigned payer representatives to determine when payment will be made and if any other information is required to adjudicate the claim.

Reviews payment discrepancies and denials identified through a payer's Explanation of Benefits (EOB), Remittance Advices (RA) or correspondence; takes appropriate action to correct the accounts.

Provides timely analysis of third party payer correspondence regarding denied claims for Coordination of Benefits (COB), accident information, student status, subrogation form and patient information needed by the insurance company for successful claim adjudication.

Conducts inquiries via telephone, mail, email, and fax or electronically through payer website for follow-up of unresolved accounts. Resubmits claims to payers as necessary, electronically, by fax, or hard copy.

Contacts the patient/guarantor for additional information that may be required for successful claim submission and adjudication (e.g. obtain requested insurance information by phone, or send demand letter to patient).

Collaborates with Management and the CBO staff to improve processes, increase accuracy, create efficiencies and achieve overall goals of the department by identifying issues, providing recommendations for improvement, etc.

Attends meetings with payer representatives and/or vendors to address outstanding issues and learn about new policies, procedures, regulations and guidelines.

Education and/or Experience

High school diploma or equivalent required. Four years of experience in patient accounting/business office environment, specifically billing and/or collections in an assigned insurance area required.

Computer Skills

Proficient in Microsoft Office software.

Meditech patient accounting system experience preferred.

Business Unit: Presence Medical Group N/T
Department Name: Burks Bromet