Responsible for the collection of unpaidthird-party claims and appeals, using various applications of JHM and JHU/ PBS billing applications. Works with the payers to resolve issues and facilitate prompt payment of claims.Follow-up with insurance companies to collect outstanding accounts for which payment has not been received in response to the claims submission process, either electronically or by paper. The Specialist will be assigned payor groups of outstanding patient accounts.Various methods of follow-up will be used including all JHU/ PBS Billing Applications.
The Specialist must have expertise in insurance follow-up processing and be knowledgeable in CPT and diagnosis coding as well as have an understanding of the JHOC registration process and be able to recognize and resolve incorrect demographic and insurance registration. The Specialist must have an understanding of claims submission requirements for all payors to expedite payments as well as knowledge of appeals and rejections processing. This position requires excellent communication skills coupled with patience and fortitude.
Principal Duties and Responsibilities:
Uses A/R follow-up systems and reports to identify unpaid claims for collection/appeal. Gathers and verifies all information required to produce a clean claim including special billing procedures that may be defined by a payer or contract. Review and update patient registration information (demographic and insurance) as needed. Applies appropriate discounts / courtesies based on department policy. Prepares delinquent accounts for transfer to self-pay collection unit according to the follow-up matrix.
Prints and mails claim forms and statements according to the follow-up matrix. Retrieves supporting documents (medical reports, authorizations, etc) as needed and submits to third-party payers. Appeals reflected claims and claims with low reimbursement. Confirm credit balances and gathers necessary documentation for processing refund. Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility Identifies insurance issues of primary vs. secondary insurance, coordination of benefits eligibility and any other issue causing non-payment of claims. Contacts the payors or patient as appropriate for corrective action to resolve the issue and receive payment of claims.
Monitor invoice activity until problem is resolved. Process daily mail, edits reports, file or pull EOB batches. Identifies and informs the supervisor / Production Unit Manager of issues or problems associated with non-payment of claims.
Comprehensive knowledge and compliance of HIPAA rules and regulations in the dissemination of patient Protected Health Information (PHI). Working knowledge of JHU/ PBS Billing Applications. Utilize online resources to facilitate efficient claims processing.
Professional & Personal Development:
Participate in on-going educational activities. Assist in the training of staff. Keep current of industry changes by reading assigned material on work related topics. Complete three days of training annually.