Accountabilities
1. Screens accounts for accurate billing information.
2. Bills and follows up on primary and secondary claims in an accurate and timely manner while meeting productivity targets. Re-files claims as needed.
3. Reviews professional bills for appropriate charges.
4. Completes all third party claims per regulations of the payor.
5. Processes and transmits electronic claims to third party payors.
6. Identifies and processes debit/credit adjustments and refunds as required.
7. Reviews accounts in work queues for proper financial information and authorization.
8. Contacts insurance companies, government agencies, or responsible party when appropriate.
9. Achieves departmental goals, such as maintaining accounts receivable days, or demonstrates acceptable progression to goal(s).
10. Verifies accuracy of payer allowances received from third party payors and follows up in a timely manner.
11. Appeals denied claims in a timely manner per payor regulations.
12. Coordinates and works with clinical operations team.
13. Assists all CHP Revenue Cycle departments with backlogged work queues.
14. Performs vital project work on a regular basis as needed. Tasks required could include in-depth analysis of root cause denials, back-tracing payment and billing information. Works with the Information Systems department to determine new rules, edits or programming build. Assists in identifying holds or issues with electronic transmissions and communicates findings to leadership.
15. Communicates with leadership on all things related to payor changes and/or issues.
16. Maintains written processes and workflows for Professional billing and follow up.
17. Maintains appropriate account documentation on billing and follow up activities.
18. Works with leadership to identify potential month end closing problems or potential denial expenses.
19. Performs other job-related duties as assigned.
