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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 delays/denials 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 amounts are 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.
• 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.

Qualifications

• High School Diploma or General Education Degree (GED).
• Typically requires 1 year of related experience in 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 (CPT, ICD-10, HCPC), and insurance/reimbursement practices.
• Ability to communicate well with people to obtain basic information (via telephone or in person).

Benefits

• Comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development.
• Base compensation listed within the 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.
• 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.