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Role Description

Independently review accounts and apply billing follow-up knowledge required for all insurance payors to ensure proper and maximum reimbursement. 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 (i.e., CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology).
• Obtain necessary documentation from various resources.
• Timely and accurately communicate with internal teams and external customers (i.e., third-party payors, auditors, other entities) and act as a liaison with external third-party representatives to validate and correct information.
• Comprehend incoming insurance correspondence and respond appropriately.
• Identify and bring patterns/trends to leadership's attention regarding coding and compliance, contracting, claim form edits/errors, and credentialing for any potential delay/denial of reimbursement.
• Obtain and keep abreast with insurance payer updates/changes, single case agreements, and assist management with recommendations for implementation of any edits/alerts.
• Accurately enter and/or update patient/insurance information into the patient accounting system.
• Appeal claims to assure contracted amount is received from third-party payors.
• Comply and maintain 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, online documentation of all activity relating to billing and follow-up efforts for each account, utilizing established guidelines.
• 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.
• Refer to the supervisor for approval or final disposition such as recommendations regarding handling of observed unusual/unreasonable/inaccurate account information.
• Approval needed to write off balances according to corporate policy.
• Handle issues outside normal scope of activity and responsibility.

Qualifications

• High School Diploma or General Education Degree (GED).
• Typically requires 1 year of related experience in a medical/billing reimbursement environment, or equivalent combination of education and experience.

Requirements

• Must perform within the scope of departmental guidelines for productivity and quality standards.
• Works independently with limited supervision.
• Accountable and evaluated to organization behaviors of excellence.
• 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.
• Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPC), and insurance/reimbursement practices.
• Ability to communicate well with people to obtain basic information (via telephone or in person).

Benefits

• 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.