Responsible for researching and resolving all unpaid insurance claims and following up on all customer inquiries/complaints related to unpaid balances.
Other duties as assigned.
Answers patient calls and researches and responds to patient concerns within 24 working hours.
Maintains knowledge of complex reimbursement methodologies in Managed Care contracts including DRG, per diem, per visit, fee schedule and surgical group methodologies.
Applies knowledge for accurate resolution of claims within contract terms.
Uses knowledge of hospital policy, department procedures, Wisconsin Uniform Billing Regulations (UB04 Manual), HMO/PPO agreements and other contractual arrangements to maintain accounts receivable, manage commercial payors, and manage appeals.
Serves as back-up to person primary on taking incoming calls. Monitors que light to ensure minimal wait times for patients in call que.
Identifies denial trends and reports issues to Insurance Follow-up Coordinator/Insurance Follow-up Supervisor for escalation with payer liaisons
Participates in cross-training efforts for specific systems based on goals set by the PFS department.
Addresses accounts qualifying to workstation within one week utilizing system specific follow up procedures.
Coordinates efforts with ancillary departments as needed in a timely manner for effective resolution.
Updates new insurance information received on an account to reflect accurate insurance plan coding to ensure accurate statements are mailed to patients.
Uses transaction codes specific to each system and links those to UB 1500 bills and agreements to process follow-up functions.
Updates and verifies payor specific account information.
Two years of business office experience in billing, customer service, or collections in a healthcare environment is required.