Specialist Billing & Insurance Follow-up Specialist
US-OR-Portland
Job ID: 21-20618
Type: Regular Full-Time
NE Davis Building
Overview
Hire On Bonus attended to this position
Are you prepared to bring your clerical acumen to a healthcare neighborhood that values your work and acknowledges it as essential to a general objective of making life much better for others? In addition to your sophisticated understanding of multi-payer system and specialized billing treatments and agreements, we’ll count on you to research study insufficient costs, analyze codes and deal with client grievances. Your desire to interact with professionalism and perseverance will show the thoughtful nature we aim to produce throughout the Legacy neighborhood.
Responsibilities
Edits expenses to make sure precision and efficiency, using understanding and understanding of Universal Billing guidelines, guidelines and claim type requirements.
Reviews and finishes essential types to guarantee precise billing. Specialized agreements and high dollar accounts might need numerous additional claim kinds, understanding of unique requirements, changes, and matrix evaluations to pay doctors:
Works carefully with payors for pre-pricing of high dollar claims to speed up claims processing.
Performs high dollar medical record coding follow-up, calling HIS to lower coding hold-ups.
Checks client market and insurance coverage details. Might be needed to validate insurance coverage for some claims:
Performs confirmation when billing high dollar accounts.
May look for life time reserve days.
Combines inpatient overlap accounts, secondary outpatient services within 72 hours of an inpatient confess.
Re-assigns claims kept in editor to guarantee re-routing to suitable biller.
Follows up for missing out on details or medical diagnosis codes.
Ensures appropriate doctor names and company numbers are noted.
Documents billing history and information for A/R Management.
Submits claims digitally and submits paper copy declares as proper.
Determines what supporting files (e.g., Medical Records, Explanations of Benefits, Itemized Bill, TAR kinds) need to be consisted of with claims and obtains if required.
Reviews and finishes Claim Edits/Daily Unbilled report, taking suitable action on each claim to decrease billing hold-ups and produce an expense.
Faxes declares to accelerate greater volume of payer repayment.
Rebills upon demand after examining account notes and figuring out action to be taken.
Initiates interim expenses, intricate internal claims needing deal tracking and participation in E-chart and/or Cerner Millennium.
May review/resolve accounts with payment inconsistencies for Medicare/Medicaid or secondary providers.
May figure out whether “split” costs is needed and demand correct billing.
May start paper modifications and/or permissions for firms needing unique kinds.
Understands and uses the appropriate treatments for crossing out modifications s/he is licensed to make.
May process flag reports making sure prompt confirmation, rebill, and/or modification of claims based upon payer action.
Provides precise Customer Service to internal and external clients relating to account status and pending actions.
Contacts clients’ households, often in delicate scenarios, to deal with billing concerns.
Works carefully with specialized agreement intermediaries: health center lawyers, ASI– debt collector, criminal activity victims, state firms, Physician workplaces and/or business contracting to make sure correct billing.
Answers all inbound phone conversation, voice mails, emails, faxes or individual demands in an expert way.
Interviews client and helps properly.
Works carefully with suppliers, clients, and members of other LHS departments.
Sets due dates for future action on accounts.
Communicates with 3rd party payers relating to bank account status. Functions towards fast resolution and payment of claims. Efficiently uses understanding of policies and practices utilized in repayment specialized location such as Government, Commercial, Medicare, Medicaid, Workers Comp or Motor Vehicle Accident protection.
Reviews notes of previous action prior to calling 3rd party payer for payment resolution.
Calls 3rd party payers to bring claims to payment as quickly as possible and get rid of any barriers that might postpone the processing of a claim.
Investigates when claims are suspended, rejected, or not sped up.
In account notes, precisely files action taken and status of claim.
Sends information mailers to clients as suitable.
Effectively utilizes proper databases to get info required to process claims.
Understands and utilizes USSP system for precise claims payment dates and quantity of payment and client balance for all Regence Blue Cross items
Obtains advantages, eligibility, PCP info, and permission details when essential to fix payment concerns.
Understands and utilizes MMIS Online system to identify OHP/Medicaid eligibility and to analyze when OHP is main or secondary payer.
Understands and utilizes internet-based payer systems to acquire eligibility permission, and claim status info.
Understands FSS– Eligibility, claim status, modification procedure.
Reviews and arranges day-to-day follow-up and other important reports.
Understands and follows follow-up Matrix (timeline) for locations of specialized, i.e., variety of days up until very first follow-up, 2nd follow-up, 3rd, and so on
Tracks and reports overall variety of accounts got weekly.
Groups accounts by payer to decrease variety of call required for follow-up procedure.
High-dollar, back-logged and call-back accounts are thought about concern.
May be accountable for processing specific reports such as Month End, Flag, Daily Unbilled, PARS, Expected Reimbursement, Carrier Code 0414, Carrier Code XX50, or HCFA electronic reports.
Tracks and reports overall variety of accounts got weekly.
May be designated to work A/R Reduction reports with accountable location.
Works efficiently with big quantities of information and information. Produces or works from several reports which might differ according to payer specialized.
Performs other tasks as needed.
May work as Notary Public
May function as “backup” for other PBS positions.
May process mail.
Acts as crucial fitness instructor to brand-new department staff members on group policies/procedures
May be designated extra tasks by management
Qualifications
Education:
High school diploma or equivalent.
Experience:
One year of health care clerical experience or relevant billing, credit/collections experience. Health care billing or credit/collections chosen. Education might be replacemented for experience requirement.
Skills:
Demonstrated understanding high dollar of billing/collection guidelines and guidelines, and specialized billing treatments and agreements.
Demonstrated attention to information.
Demonstrated understanding of multi-payor systems.
Knowledge of online systems for eligibility, status evaluation of claims and getting in claims by hand
Net typing of 40 wpm and PC based computer system abilities.
Ten essential efficiency.
Knowledge of medical terms.
Ability to work effectively with very little guidance, working out independent judgment within mentioned standards.
Demonstrated reliable social abilities which promote cooperation and team effort.
Ability to stand up to differing task pressures and organize/prioritize associated task tasks.
Demonstrated efficient social abilities which promote cooperation, team effort, and regard.
Excellent public relations ability and showed capability to interact in calm, professional way.
Ability to adjust to alter.
Demonstrated negotiating, analytical and decision-making abilities.
LEGACY’S VALUES IN ACTION:
Follows standards stated in Legacy’s Values in Action.
Equal Opportunity Employer/Vet/Disabled
PI152424392
Tradition Health.
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