Claims Follow Up Rep

Summary : Under

general supervision of the Follow-up Supervisor performs all duties necessary

to follow up on outstanding claims and correct all denied claims for a large

physician specialty practice.

Responsibilities : Review all

denied claims correct them in the system and send corrected / appealed claims as

written correspondence fax or via electronic submission.

Identify

and analyze denials and enact corrective measures as needed to effectively

communicate and resolve payer errors.

Continually

maintain knowledge of payer specific updates via payers listservs provider

updates webinars meetings and websites.

Understand

and maintain compliance with HIPAA guidelines when handling patient information

Contact

internal departments to acquire missing or erroneous information on a claim

resulting in adjudication delays or denials.

Report to

supervisor identification of denial trends resulting revenue delays.

Answers

telephone inquiries from 3rd party payers; refer all unusual requests to

supervisor.

Retrieve

appropriate medical records documentation based on third party requests.

Refer all

accounts to supervisor for additional review if the account cannot be resolved

according to normal procedures.

Work with

management to improve processes increase accuracy create efficiencies and

achieve the overall goals of the department.

Maintain

quality assurance safety environmental and infection control in accordance

with established policies procedures and objectives of the system and

affiliates.

Perform

other related duties as required.

Other information : BASIC

KNOWLEDGE : Equivalent

to a high school graduate.

Knowledge

of 3rd party billing to include ICD CPT HCPCS and 1500 claim forms.

Demonstrated

skills in critical thinking diplomacy and relationship-building.

Highly

developed communication skills successfully demonstrated in effectively

working with a wide variety of people in both individual and team settings.

Demonstrated

problem-solving and inductive reasoning skills which manifest themselves in

creative solutions for operational inefficiencies.

EXPERIENCE : One to

three years of relevant experience in professional billing preferred.

Experience

with Epic a plus.