Professional Billing Denials and Follow Up Representative

divh2Professional Billing Denials and Follow Up Representative/h2pAt Northwestern Medicine, every patient interaction makes a difference in cultivating a positive workplace. This patient-first approach is what sets us apart as a leader in the healthcare industry. As an integral part of our team, youll have the opportunity to join our quest for better health care, no matter where you work within the Northwestern Medicine system. We pride ourselves on providing competitive benefits: from tuition reimbursement and loan forgiveness to 401(k) matching and lifecycle benefits, our goal is to take care of our employees. Ready to join our quest for better?/ppThe Professional Billing Denials and Follow Up Representative reflects the mission, vision, and values of NM, adheres to the organizations Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards./ppstrongResponsibilities:/strong/pulliConsistently meet the current productivity and quality standards in timely resolution of all claim edits, reporting of candidates for bill, outbound compliant claim submission, clinical documentation requirements and any other communication required (verbal or written) regarding claims ensuring timely filing of claims and clean, complete and accurate claims./liliConsistently meet or exceed productivity standards, targets, error ratios, and reporting requirements assigned by the Patient Accounting Lead Financial Assessor and Operations Coordinator./liliTimely follow-up and collection of third party payer receivables. Denials and Appeals follow-up including root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution./liliCompliant follow-up correspondence to third party payers regarding outstanding accounts receivables (i.e. Statements, letters, e-mails, faxes, portal mail, etc.)./liliSupport the operations related to optimum third party accounts receivables (i.e. Managed Care, Commercial, Medicare, Medicaid, Replacement plans, Workers Compensations, Corporate Accounts, Research, and Specialty AR Accounts)./liliPerform daily, systematic reviews of work lists to ensure all accounts already to be worked are completed./liliUtilize Government, Commercial, and regulatory guidelines for collection of outstanding accounts. Recommend accounts for contractual or administrative write-off and provide appropriate justification and documentation./liliPractice HIPAA privacy standards and ensure compliance with patient health information privacy practices. Provide individual contribution to the overall team effort of achieving the department accounts receivable goals./liliIdentify opportunities for customer, system and process improvement and submit to management./liliFollow the NMHC general Policy and Procedures, the Departmental Policy and Procedures, and any Emergency Preparedness Procedures. Follow Joint Commission and outside regulatory agencies mandated rules and procedures./liliUtilize assigned menus and pathways in the hospital mainframe system and report software application problems to the appropriate supervisor./liliUtilize assigned menus and pathways in external software applications and report software application problems to the appropriate supervisor./liliUtilize assigned computer hardware and report hardware problems to the appropriate supervisor./liliParticipate in the testing for assigned software applications, including verification of field integrity./liliAssist the Patient Accounting Operational Coordinator and Patient Accounting Team Lead Financial Assessor with special projects and other duties as assigned, as necessary./liliAttend training and seminars as assigned and approved by the Patient Accounting Operations Coordinator./li/ulpAdditional Responsibilities:/pulliDemonstrate excellent customer service through oral and written communication in providing assistance/expertise to patients, authorized guarantors, and other external and internal contacts./liliDemonstrate proficient use of systems and execution of processes in all areas of responsibilities./liliWorking knowledge of physician and facility billing and follow-up including understanding of insurance rules and regulations especially Medicare and Medicaid. Knowledge of HIPAA standards./liliAbility to perform mathematical calculations./liliExcellent communication skills when dealing with patients, families, public, co-workers, and professional offices. Basic knowledge of medical terminology and billing practices/li/ulpRequired:/pulliHigh School diploma/liliOne year related work experience or college degree/liliAbility to perform mathematical calculations/liliBasic knowledge of medical terminology and billing practices/liliExtensive experience and knowledge of PC applications, including Microsoft Office and Excel/liliLearn quickly and meet continuous timelines/liliExhibit behaviors consistent with principles of excellent service./li/ulpPreferred:/pulliTwo or more years college or college degree./liliCall center, telephone work experience or cash collections experience./liliKnowledge of Epic Systems./liliTwo (2) years progressive work experience in a hospital/ physician billing or SBO environment./liliDetail-oriented, good organizational skills, and ability to be self-directed./liliStrong time management skills, managing multiple priorities and a heavy workload in a high-stress atmosphere./liliFlexibility to perform other tasks as needed in an active work environment with changing work needs./liliHigh-level problem solving, analytical, and investigational skills./liliExcellent internal/external customer service skills./li/ul/div