Billing Insurance Follow-up - Milwaukee, United States - Sixteenth Street Community Health Centers
Description
Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge (i.e., 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 (i.e., 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 leadership's attention re: coding and compliance, contracting, claim form edits/errors and credentialing for any potential 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.
- Appeals claims to assure contracted amount is received from third party payors.
Compile information for referral of accounts to internal/external partners as needed.
- Compile and maintain clear, accurate, online documentation of all activity relating to billing and follow up efforts for each account, utilizing established guidelines.
- Demonstrate proficiency in proper use of the software systems employed by SSCHC.
This position refers to the supervisor for approval or final disposition such as: recommendations regarding handling of observed unusual/unreasonable/inaccurate account information.
- Approval is needed to write off balances according to corporate policy. Issues outside normal scope of activity and responsibility.
QUALIFICATIONS:
- High School Diploma or General Education Degree (GED)
- Typically requires 1 year of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience.
- Experience in EPIC preferred.
- Must perform within the scope of departmental guidelines for productivity and quality standards.
- Works independently with limited supervision.
- Accountable and evaluated to organization behaviors of excellence.
- Basic keyboarding proficiency.
- Must be able to operate computer and software systems in use at Sixteenth Street Community Health Center.
- Ability to read, write, speak and understand English proficiently.
- Ability to read and interpret documents such as explanation of benefits (EOB), operating instructions and procedure manuals.
- Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD10, HCPC) and insurance/reimbursement practices.
- Ability to communicate well with people to obtain basic information (via telephone or in person).
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