MAJOR RESPONSIBILITIES

Responsible for daily claims submissions (electronic transmittals, personal computer applications and hard copy claims) to the appropriate responsible parties. Acts as a resource person, assists teams with more complex issues, works with team members to facilitate problem resolution and may provide training. May be involved in quality audit process,    productivity, and special projects as assigned. 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 (ie;CPT,ICD-10 and HCPCS, NDC, revenue codes and medical terminology).Will obtain necessary  documentation from various resources.Ability to timely and accurately communicate with internal teams and external customers (ie;third party payors, auditors, other entity) via phone or mail and acts as a liaison with external third party payer (insurance) representatives to validate and correct information and ensure regulatory and contractual compliance. Comprehends incoming insurance correspondence and responds appropriately.Identifies and brings patterns/trends to leaderships attention re:coding and compliance, contracting, claim form edits/errors and credentialing for any potential in delay/denial of reimbursement. Obtains and keeps abreast with insurance payer updates/changes, single case agreements and assists  management with recommendations for implementation of any edits/alerts.Accurately enters and/or updates patient/insurance information into patient accounting system. Appeals claims to assure contracted amount is received from third party payors.Complies and maintains 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, on-line documentation of all activity relating to billing and collection efforts for each account, utilizing established guidelines. Responsible to 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.This position refers 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 balance’s according to corporate policy. Issues outside normal scope of activity and responsibility.

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

Level of Education:  High School Diploma or General Education Degree (GED)Years of Experience:  Typically requires 2 years of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience.

MINIMUM KNOWLEDGE, SKILLS AND ABILITIES (KSA)

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.Knowledge of medical terminology, coding, terminology (CPT,ICD-10,HCPC) and insurance/reimbursement practices.Ability to problem solve complex billing, coding and contract issues.Able to use Zoom, Microsoft office, or other communication software for meetings.Proficient knowledge base and understanding of department-specific policies and procedures.Strong analytic, organization, communication (written and verbal), and interpersonal skills.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.