• Job Description

  Req#: R160396

  Department:

  10413 Enterprise Revenue Cycle - HB Non Government Payer Follow Up

  Status:

  Full time

  Benefits Eligible:

  Yes

  Hou rs Per Week:

  40

  Schedule Details/Additional Information:

  Weekdays

  Primary Purpose

  Responsible for the timely processing of insurance claims, which includes but is not limited to electronic transmissions, account, and other third-party billing. Conducts prompt collection of accounts receivable by reviewing assigned accounts for problems delaying payment, and by facilitating the effective resolution of problems. Acts as a department resource and assists teams with more complex issues. Support complex billing, coding, and reimbursement issues. Actively following up with insurance carriers on open insurance claims. Team member must have an understanding of contractual relationships. Supports complete and timely revenue collection from patients, third party payors, via accurate entry and/or correction of patient, charges and insurance information into the system. Brings patterns/trends to coding and compliance, contracting and credentialing for any potential in delay/denial of reimbursement. To act as a resource and mentor and assist in the development of Billing Follow Up I, working one-on-one with them in problem resolution. Assists management team with the development of protocols and procedures to include operating systems.

  Major Responsibilities

  • Responsible for daily claims submissions (electronic transmittals, personal computer applications and hard copy claims) to the appropriate responsible parties. Acts as a resource person, assists teams with more complex issues, works with team members to facilitate problem resolution and may provide training. May be involved in quality audit process, productivity, and special projects as assigned. Uses multiple systems to resolve outstanding claims according to compliance guidelines.
  • Prebilling/billing and follow up activity on open insurance claims exercising revenue cycle knowledge (ie;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 (ie;third party payors, auditors, other entity) via phone or mail and acts as a liaison with external third party payer (insurance) representatives to validate and correct information and ensure regulatory and contractual compliance. Comprehends incoming insurance correspondence and responds appropriately.
  • Identifies and brings patterns/trends to leaderships attentionrecoding and compliance, contracting, claim form edits/errors and credentialing for any potential in 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.
  • Accurately enters and/or updates patient/insurance information into patient accountingsystem. Appeals claims to assure contracted amount is received from third party payors.
  • Complies and maintains KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines. Compile information for referral of accounts to internal/external partners as needed. Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and collection efforts for each account, utilizing established guidelines.
  • Responsible to read and understand all Advocate Aurora Health policies and departmental collections policies and procedures. Demonstrate proficiency in proper use of the software systems employed by AAH.
  • This position refers to the supervisor for approval or final disposition such as: recommendations regarding handling of observed unusual/unreasonable/inaccurate accountinformation. Approval needed to write off balance's according to corporate policy. Issues outside normal scope of activity and responsibility

  Minimum Job Requirements

  Education: High School Diploma or General Education Degree (GED)

  Certification / Registration / License

  Work Experience: Typically requires 2 years of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience.

  Knowledge / Skills / Abilities

  • Basic keyboarding proficiency.
  • Must be able to operate computer and software systems in use at Advocate Aurora Health.
  • Able to operate a copy machine, facsimile machine, telephone/voicemail.
  • 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.
  • Knowledge of medical terminology, coding, terminology (CPT,ICD-10,HCPC) and insurance/reimbursement practices.
  • Ability to problem solve complex billing, coding and contract issues.
  • Able to use Zoom, Microsoft office, or other communication software for meetings.
  • Proficient knowledge base and understanding of department-specific policies and procedures.
  • Strong analytic, organization, communication (written and verbal), and interpersonal skills.

  Pay Range

  $21.45 - $32.20

  Our Commitment to You:

  Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

  Compensation

  • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
  • Premium pay such as shift, on call, and more based on a teammate's job
  • Incentive pay for select positions
  • Opportunity for annual increases based on performance

  Benefits and more

  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

  About Advocate Health

  Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

• About the company

  Advocate Aurora Health is a non-profit health care system with dual headquarters located in Milwaukee, Wisconsin

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