Claim Specialist II - Greensboro, United States - Cone Health

Cone Health Greensboro, United States

2 hours ago

Description

Claim Specialist II

ID

Location

Professional Fee Billing

Work Location

US-NC-Greensboro

Division :
Name

System Wide

Department :
Name

SW-Pro Fee Billing

Category

CLERICAL/ADMIN

Position Sub-Category

INSURANCE/BILLING

Position Type

Full Time (40 hours/week)

Employment Type

Employee

Exempt/NonExempt

Non-Exempt

FTE
1.00

Workforce Status

Hybrid I

Work Hours

40.00

Provider Schedule (specific schedule)

8am - 5pm

On call Required

No

Sub Category

Insurance/Billing

Overview

Monitors the volume and accuracy of Pro Fee claims and revenue cycle processes by monitoring workqueues for increased volume of rejections, denials or other unfavorable trends.

Analyze results to identify if issues are user related, system related or payer related.

Communicated with Central Billing Office leadership, vendors and IT any identified issues that may improve efficiency and maximize the accuracy of claims submissions.

Talent Pool:
Corporate Services/Professional

Responsibilities

End User Support

Reviews end users issues, workflow problems and provide updates to team leaders of identified issues and trends.
Assist end users with questions regarding resolution of errors in workqueues

System Issue Resolution

Ensure assigned workqueues have edits resolved in a timely manner
Identify trends within the system creating successful claim submission and communicate to Pro Fee Business Liaison and Information Systems
Assures timely and accurate account billing to third party payers via electronic and paper claims submissions
Assures timely response to third party payers? requests for additional information in addition to claims follow up for denials and no response
Serve as resource for other CBO staff in resolving more difficult claim issues that may need escalating to CBO leadership
Must be able to analyze issues and effectively communicate to leadership and other teams cause, effect, and solutions to eliminate errors or negative impact trends
Must have thorough knowledge of billing system and workflows throughout the entire revenue cycle process and their impact on revenue outcomes

Communication

Provides communication regarding issues resulting from the frontend functions negatively impacting revenue to Pro Fee Business Liaison, Pro Fee Leadership and Information Systems for resolution.
Establish relationships with third party payers to assist in timely resolution of claim errors, establish forums for regular communication of issues/changes between the vendor or third party and Cone Central Business office

Compliance.

Ensures that Revenue Cycle services are provided in accordance with state and Federal regulations, organizational policy, and accreditation/compliance requirements.
Maintains compliance to all regulatory requirements/laws as they relate to responsibilities (Corporate Compliance, HIPPA, etc.).
Remains current through education, inservices, etc

Qualifications

EDUCATION: High School Diploma or equivalent, Required
Associates, Preferred in Business or Healthcare; RHIT preferred

EXPERIENCE: Minimum 3 years' experience, Required
5+ years of experience, Preferred*
*Require minimum 3 years in a professional fee billing environment and/or physician practice operations.
**Prefer 5 + years in a medical/insurance environment for physician/professional billing revenue cycle.
Epic experience preferred.

LICENSURE/CERTIFICATION/REGISTRY/LISTING: REQUIRED

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