Able to perform all of the duties of a physician insurance analyst I and II. Responsible for the timely and accurate editing, submission, and/or follow-up of assigned claims, while meeting the expected productivity and quality standards on a weekly basis. Able to process claims for all payer types (Commercial, Managed Care, Blue Cross, Medicare, Medicaid, etc.) Assure all assigned claims meet clearinghouse and/or payer processing criteria. Able to process (level 1 and 2) and check claim status via phone/payer website. Payer response reports and rejection reports are worked timely and meet Departmental Productivity and Quality Review standards. Assure appropriate and timely documentation of all account activity. Correspondence is handled appropriately. Complete all assigned EPIC billing/claim edits and insure all required reports are filed timely and accurately. Identify opportunities for revenue cycle performance improvements and report to management team. Identify and report trends, assist in the development and deployment of training relative to trends.
Review and resolve claim edits and payer rejections to ensure accurate and timely bill submission to insurance payers. Adhere to government regulations and payer billing guidelines for compliant billing.
Print and submit supplemental billing documentation, including but not limited to hardcopy claim forms, itemized bills, and/or medical records, as needed.
Complete secondary and tertiary billing functions, as applicable, including submission of remittance advices or explanation of benefits forms.
Identify, research, and resolve unusual, complex or escalated claim issues. Notify Supervisor of developing trends and propose recommended resolution steps based on impacted payer and dollar amounts.
Notate all activities and findings in the billing system and in accordance with established policies and procedures to meet quality assurance and documentation standards.
Monitor and complete accounts assigned to PFS Representative through ownership of predetermined workqueues. Notify Supervisor of changes in volumes that may impact daily billing of claims.
Establish and maintain a professional and collaborative relationship with payers and Inova staff in order to resolve claim edits and payer rejections. Understand Revenue Cycle responsibilities as they pertain to billing functions and communicate with other Revenue Cycle departments to resolve billing issues.
Maintain knowledge of current payer billing requirements. Communicate new trends and developments to team to ensure accurate and consistent billing practices across the SBO Billing Department.
Meet department-specified productivity and quality standards.
Perform related duties as required or assigned by SBO Billing Department leadership.
Additional Responsibilities and Requirements:
Meet established deadlines, prioritize multiple tasks/assignments, and handle constantly changing work environment.
Adhere to state and federal regulations and Inova Health System policies and procedures pertaining to accurate and compliant billing practices.
Strong interpersonal communication skills with an ability to work both independently and collaboratively as part of a team.
Perform other duties as assigned by SBO Billing Department leadership.
Maintain acceptable levels of attendance and punctuality as outlined in Inova's policies and procedures.
Additional Knowledge / Skills / Abilities:
Effective written and verbal communication skills.
Excellent time management, organizational, and prioritization skills.
Proficient with Microsoft Office programs, including but not limited to Word, Excel, and Outlook.
Strong analytical and critical thinking skills.
Knowledge of professional billing, including insurance payer contract structures and billing requirements.
Fluency in medical terminology and billing processes.
Experience with electronic medical records systems. Epic system experience preferred.
Internal Number: 51327BR
About Inova Health System
Inova is a global leader in personalized health, which leverages precision medicine to predict, prevent and treat disease, enabling individuals to live longer, healthier lives. At Inova, we serve more than two million people each year from throughout the Washington, DC, metro area and beyond. Inova's mission is to improve the health of the diverse community it serves through excellence in patient care, education and research. At Inova, more than 16,000 employees demonstrate their commitment every day to providing the community with expert, world-class, compassionate patient care.