Process Billing by receiving, interpreting, processing, and submitting through various edits to third party payors billing electronically and hard copy format.
Billing follow up by contacting third party payers or accessing payer websites/provider portals to determine payment expectation and resolve any problem on the claim.
Information communications and processing by interpreting and processing third party payor and patient inquiries in an accurate and timely manner to expedite payment. Denial Management:
Manage denial receivable to resolve accounts
Develops strategy for appeal, appeal follow-up and/or reprocessing accounts
Analyze denials to determine reason they occurred
Identifies trends and reports significant and recurring issues along with possible solutions to Denials Management Supervisor and Billing Manager
Takes corrective action through systematic and procedural development to reduce or eliminate payment issues Contract Management:
Familiarity with payer methodologies and the ability to communicate with NMHS staff
Manage paid claims to resolve underpaid accounts
Develops strategy for appeal, appeal follow-up and/or reprocessing accounts
Analyze underpayments to determine reason they occurred
Identifies trends and reports significant and recurring issues along with possible solutions to the Denials and Underpayment manager. Communication:
Professionally and effectively communicates with third party carriers, vendors, and hospital contacts to promote contractual compliance Liaison:
Contacts insurance companies regarding denial, underpayments or rejection issues
Serves as liaison between payers and hospital departments/physician offices or patients in resolving denials and/or underpayment issues Reporting:
Assists in preparation of monthly denial reports and other denial reports as requested
Assists in preparation of monthly variance reports and other variance reports as requested. Regulation:
Adheres to NMHS/NMMC Policies/Procedures/Guidelines.
Complies with applicable Local/State/Federal policies/procedures/guideline/regulations/laws/statues.
Job Knowledge
Bachelors degree in business, coding or equivalent field required; with a minimum of 2-year Claims, Billing/ Follow-Up, or revenue cycle experience required. Willing to consider 6 yrs Claims, Billing/Follow-Up, or revenue cycle experience beyond minimum requirement in lieu of degree.
Experience/knowledge of managed care reimbursement methodology including ICD-10, CPT-4 and/or HCPCS and DRGs, required
Ability to research, analyze and communicate payer trends to identify reimbursement and training issues.
Excellent analytical and problem-solving skills required
Good organizational and communication (written and verbal) skills; required
Computer skills with strong Microsoft Office, Outlook, Third Party Payer websites; preferred