Billing Follow Up Rep Level II – Durable Medical Equipment DME

Billing Follow Up Rep Level II – Durable Medical Equipment DME

Requirements

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

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.

Preferred Qualifications

No preferred qualifications provided.