Prepares and submits claims. Proficient at management of assigned inventory.
Follows-up on insurance claims within required timeframes.
Accurately prepare and submit claims in the work queue within the required time frame afternoon billing information is available, following all organization, payer and regulatory guidelines. (Institutional and Professional). Proficient at management of assigned inventory (single service line).
Follow-up on insurance claims within 30 days of billing for commercial payers and 21 days of billing for government payers. Maintain ATB for assigned accounts > 90 days from discharge at <28% of total AR. Monitor KPI's and report weekly/monthly as required. Obtain additional information from patient/guarantor as needed for claims processing.
Submit claims edits to CDM specialist or HIM coder queue as appropriate based on code origination.
Respond to Customer Service inquiries within 48 hours of request.
Review and process assigned correspondence daily.Process denials and appeals at a minimum weekly.
Expedite resolution for denial and rejected claims, referring these to the immediate supervisor when > 3 attempts are made without claims adjudication
Obtain additional information from patient/guarantor as needed for claims processing.
Contribute to department process improvement activities
Model the principles of "Just Culture".
Performs other duties as assigned. Compliant with HIPAA, The Joint Commission and other regulatory agencies as required.