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 payer*s 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.

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.

Location: Corporate Headquarters USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union