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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.
• Utilize multiple systems to resolve outstanding claims according to compliance guidelines.
• Conduct prebilling/billing and follow-up activity on open insurance claims exercising revenue cycle knowledge (e.g., CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology).
• Obtain necessary documentation from various resources.
• Communicate timely and accurately with internal teams and external customers (e.g., third-party payors, auditors) 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.
• Stay updated 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 ensure contracted amounts are received from third-party payors.
• Comply and maintain KPI (Key Performance Indicators) for assigned payers within standards established by the 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 regarding unusual/unreasonable/inaccurate account information.
• Obtain 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 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 organizational 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, HCPCS), 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, and programs that invest in your career development.
• Base compensation listed within the pay range based on 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.