Billing Follow Up Representative I

Major Responsibilities

• Independently review accounts and apply billing follow-up knowledge required for all insurance payors to ensure proper and maximum reimbursement.
• Use multiple systems to resolve outstanding claims according to compliance guidelines.
• Perform pre-billing, billing, and follow-up activity on open insurance claims using revenue cycle knowledge including CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology.
• Communicate timely and accurately with internal teams and external customers, including third-party payors and auditors, to validate and correct information.
• Review incoming insurance correspondence and respond appropriately.
• Identify patterns and trends related to coding, compliance, contracting, claim form edits/errors, and credentialing that may contribute to delays or denials of reimbursement.
• Stay current on insurance payer updates, changes, and single case agreements, and assist management with recommendations for edits and alerts.
• Enter and update patient and insurance information in the patient accounting system.
• Appeal claims to help ensure contracted amounts are received from third-party payors.
• Maintain KPI performance standards for assigned payers.
• Compile referral information for internal and external partners as needed.
• Maintain clear, accurate, online documentation of all billing and follow-up activity for each account.
• Follow Advocate Aurora Health policies and departmental collections policies and procedures.
• Escalate unusual, unreasonable, or inaccurate account issues to supervision for approval or final disposition.