Claims Follow Up Rep

Under

general supervision of the Follow-up Supervisor performs all duties necessary

to follow up on outstanding claims and correct all denied claims for a large

physician multi-specialty practice.

Responsibilities

Review all denied claims correct them in the system and send corrected/appealed claims as

written correspondence fax or via electronic submission.

Identify and analyze denials and enact corrective measures as needed to effectively

communicate and resolve payer errors.

Continually maintain knowledge of payer specific updates via payer?s listservs provider

updates webinars meetings and websites.

Understand and maintain compliance with HIPAA guidelines when handling patient information

Contact internal departments to acquire missing or erroneous information on a claim

resulting in adjudication delays or denials.

Report to supervisor identification of denial trends resulting in revenue delays.

Answers telephone inquiries from 3rd party payers; refer all unusual requests to

supervisor.

Retrieve appropriate medical records documentation based on third party requests.

Refer all accounts to supervisor for additional review if the account cannot be resolved

according to normal procedures.

Work with management to improve processes increase accuracy create efficiencies and

achieve the overall goals of the department.

Maintain quality assurance safety environmental and infection control in accordance

with established policies procedures and objectives of the system and

affiliates.

Other Information

Perform other related duties as required.

BASIC

Knowledge

Equivalent

to a high school graduate.

Knowledge

of 3rd party billing to include ICD CPT HCPCS and 1500 claim forms.

Demonstrated

skills in critical thinking diplomacy and relationship-building.

Highly

developed communication skills successfully demonstrated in effectively

working with a wide variety of people in both individual and team settings.

Demonstrated

problem-solving and inductive reasoning skills which manifest themselves in

creative solutions for operational inefficiencies.

Experience

One to

Experience

three years of relevant experience in professional billing preferred.

with Epic a plus.

Independent Action

Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action.

Supervisory Responsibility

None

Brown University Health is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union