Billing Follow Up- Representative I
Advocate Health Care, Oak Brook, IL, United States
Major Responsibilities
Independently review accounts and apply billing follow‑up knowledge required for all insurance payors to insure proper and maximum reimbursement. Uses multiple systems to resolve outstanding claims according to compliance guidelines.
Pre‑billing / billing and follow‑up activity on open insurance claims exercising revenue cycle knowledge (e.g., CPT, ICD‑10, 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 (e.g., third‑party payors, auditors, other entities) and act as a liaison with external representatives to validate and correct information.
Comprehend incoming insurance correspondence and respond appropriately. Identify and bring patterns/trends to leadership’s attention regarding coding and compliance, contracting, claim form edits/errors and credentialing for any potential delay/denial of reimbursement. Keep abreast with insurance payer updates/changes, single case agreements and assist management with recommendations for implementation of any edits/alerts.
Accurately enter and/or update patient/insurance information into the patient accounting system. Appeal claims to assure contracted amount is received from third‑party payors.
Comply with and maintain KPI (Key Performance Indicators) for assigned payers within standards established by the department and insurance guidelines.
Compile information for referral of accounts to internal/external partners as needed. Maintain clear, accurate online documentation of all activity relating to billing and follow‑up efforts for each account, utilizing established guidelines.
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.
Refer 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 balances 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 1 year of related experience in a medical/billing reimbursement environment, or an equivalent combination of education and experience.
Minimum Knowledge, Skills And Abilities (KSA)
Must perform within the scope of departmental guidelines for productivity and quality standards.
Works independently with limited supervision.
Accountable and evaluated to organization behaviors of excellence.
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.
Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD‑10, HCPC) and insurance/reimbursement practices.
Ability to communicate well with people to obtain basic information (via telephone or in person).
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.
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Independently review accounts and apply billing follow‑up knowledge required for all insurance payors to insure proper and maximum reimbursement. Uses multiple systems to resolve outstanding claims according to compliance guidelines.
Pre‑billing / billing and follow‑up activity on open insurance claims exercising revenue cycle knowledge (e.g., CPT, ICD‑10, 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 (e.g., third‑party payors, auditors, other entities) and act as a liaison with external representatives to validate and correct information.
Comprehend incoming insurance correspondence and respond appropriately. Identify and bring patterns/trends to leadership’s attention regarding coding and compliance, contracting, claim form edits/errors and credentialing for any potential delay/denial of reimbursement. Keep abreast with insurance payer updates/changes, single case agreements and assist management with recommendations for implementation of any edits/alerts.
Accurately enter and/or update patient/insurance information into the patient accounting system. Appeal claims to assure contracted amount is received from third‑party payors.
Comply with and maintain KPI (Key Performance Indicators) for assigned payers within standards established by the department and insurance guidelines.
Compile information for referral of accounts to internal/external partners as needed. Maintain clear, accurate online documentation of all activity relating to billing and follow‑up efforts for each account, utilizing established guidelines.
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.
Refer 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 balances 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 1 year of related experience in a medical/billing reimbursement environment, or an equivalent combination of education and experience.
Minimum Knowledge, Skills And Abilities (KSA)
Must perform within the scope of departmental guidelines for productivity and quality standards.
Works independently with limited supervision.
Accountable and evaluated to organization behaviors of excellence.
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.
Preferred but not required knowledge of medical terminology, coding, terminology (CPT, ICD‑10, HCPC) and insurance/reimbursement practices.
Ability to communicate well with people to obtain basic information (via telephone or in person).
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.
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