Associate Billing and Collections Representative – Eligibility
Providence
Contract Compliance Specialist
Advocate Aurora Health
full-time
Posted on:
Origin: • 🇺🇸 United States • Illinois
Visit company websiteSalary
💰 $23 - $34 per hour
Job Level
Mid-LevelSenior
About the role
- Collect Underpayment Reimbursement due for AAH Illinois hospitals and physicians from payers according to Federal/State/Local Regulations and contractual obligations
- Perform analysis of underpaid claims in order to determine appropriate course of action
- Identify and review documentation and specific account information to determine validity of underpayment
- Utilize payment variance workflow tools to initiate follow up and tracking
- Maintain strong knowledge of the requirements and contract obligations for all payers including current policies and procedures as related to payment variance management
- Document workflow tool with accurate, clear, and concise notes
- Identifies, analyzes, and researches payment variance root causes and trends
- Assists in the development of corrective action plans for resolution of underpayments and insurance credit payment variances
- Investigates and generates reports to identify all accounts applicable to a particular trend and/or root cause
- Collaborates with internal and external stakeholders to initiate corrective action plans to minimize preventable underpayments
- Monitor the progress and resolution of trends; evaluate the financial impact for the Revenue Cycle
- Identify and report new trends to management during weekly meetings
- Determine educational opportunities for underpayment trends with internal and external partners to improve processes for underpayment avoidance
- Identify insurance and patient refunds to refer to the Refund Team
Requirements
- Associate’s Degree or 3-5 years recent experience in hospital billing, hospital collections, payer contracting, or claims department within a health insurance setting
- Plus at least 3 years claims processing/ adjudication experience including demonstrated success in utilizing problem solving and communication skills to diagnose problems and resolve complicated issues
- Knowledge of third-party payer, Medicare/Medicaid guidelines
- Understanding of Medical terminology
- Experience in managed care contracts, reconciling patient accounts, and balancing payment transactions against contract rates and terms is strongly desired
- Ability to interpret contract terms is required
- Knowledge of UB-04 requirements
- Knowledge of CPT, HCPCs coding
- 35 wpm typing preferred
- Computer skills with strong Microsoft Office (Excel and Word), Outlook, Third Party Payer websites, and NEBO/Passport products including ECARE Online and ECARE Claims Management System
- Ability to perform root cause analysis, problem solve, and prepare action plans for improvement initiatives
- Effective negotiating skills including the ability to resolve difficult claims issues
- Strong Analytical Skills
- Strong interpersonal, communication & persuasion/negotiation skills
- Ability to listen to and understand information and ideas presented verbally and in writing
- Consistently exercises critical thinking skills or use logic and reasoning to assess and resolve problems
- Ability to work under pressure and meet stringent deadlines in a fast-paced environment
- Ability to work independently
- Pays strong attention to details and maintains high degree of accuracy
- Successfully alternates between two or more activities or sources of information
- Accepts responsibility and maintains high level of accountability
- Strong collaboration skills
- Available to respond to patient/third party requests during scheduled shift
- Ability to work on a computer for extended periods of time
- Ability to speak on phone throughout a daily assigned shift (with opportunity to alternate between sitting and standing if necessary)
- Ability to work effectively in an open floor environment
