Claims Follow Up Rep - Providence, United States - Lifespan
Description
Remote ScheduleSummary:
Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital.
Responsibilities:
Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system.
Responsible for knowing and acting in accordance with the principles of the Lifespan Corporate Compliance Program and Code of Conduct.
Review claim forms for all required data fields depending on the specific 3rd party requirements. Review patient account for demographic accuracy.
Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data.
Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer's contracts or Federal reimbursement methods.
Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment.
Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language.
Continually maintains knowledge of payer specific updates via payer's listservs, provider updates, webinars, meetings and websites.
Review payer's settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer's policies and each individual related contract.
Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.
Initiate adjustments to payer's as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials.
Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials.
Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown.
Answer telephone inquiries from 3rd parties and interdepartmental calls. Refer all unusual requests to supervisor.
Retrieve appropriate medical records documentation based on third party requests.
Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations.
Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures.
Works with supervisor, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
Maintain quality assurance, safety, environmental and infection control in accordance with established policies, procedures, and objectives of the system and affiliates.
WORK LOCATIONS/EXPECTIONS:
After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure.
Full time schedule worked in a dedicated space in the home
Part time schedule in office and in a dedicated space within the home
Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule.
Other information:
BASIC KNOWLEDGE:
Equivalent to a high schoo
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