Claim Specialist II

ID 2022-10423
Location
Professional Fee Billing
Work Location
US-NC-Greensboro
Division : Name
Finance
Department : Name
SW-Pro Fee Billing
Category
CLERICAL/ADMIN
Position Sub-Category
INSURANCE/BILLING
Position Type
Full Time
Employment Type
Employee
Exempt/NonExempt
Non-Exempt
FTE
1.00
Provider Schedule (specific schedule)
Monday - Friday
On call Required
No
Sub Category
Insurance/Billing

Overview

Monitors the volume and accuracy of Pro Fee claims and revenue cycle processes by monitoring workqueues for increased volume of rejections, denials or other unfavorable trends. Analyze results to identify if issues are user related, system related or payer related. Communicated with Central Billing Office leadership, vendors and IT any identified issues that may improve efficiency and maximize the accuracy of claims submissions.

Responsibilities


End User Support

- Reviews end users issues, workflow problems and provide updates to team leaders of identified issues and trends.

- Assist end users with questions regarding resolution of errors in workqueues

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System Issue Resolution

- Ensure assigned workqueues have edits resolved in a timely manner

- Identify trends within the system creating successful claim submission and communicate to Pro Fee Business Liaison and Information Systems

- Assures timely and accurate account billing to third party payers via electronic and paper claims submissions

- Assures timely response to third party payers? requests for additional information in addition to claims follow up for denials and no response

- Serve as resource for other CBO staff in resolving more difficult claim issues that may need escalating to CBO leadership

- Must be able to analyze issues and effectively communicate to leadership and other teams cause, effect, and solutions to eliminate errors or negative impact trends

- Must have thorough knowledge of billing system and workflows throughout the entire revenue cycle process and their impact on revenue outcomes

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Communication

- Provides communication regarding issues resulting from the front-end functions negatively impacting revenue to Pro Fee Business Liaison, Pro Fee Leadership and Information Systems for resolution.

- Establish relationships with third party payers to assist in timely resolution of claim errors, establish forums for regular communication of issues/changes between the vendor or third party and Cone Central Business office

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Compliance.

- Ensures that Revenue Cycle services are provided in accordance with state and Federal regulations, organizational policy, and accreditation/compliance requirements.

- Maintains compliance to all regulatory requirements/laws as they relate to responsibilities (Corporate Compliance, HIPPA, etc.).

- Remains current through education, in-services, etc

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Qualifications


EDUCATION:
High School Diploma or equivalent, Required

Associates, Preferred in Business or Healthcare; RHIT preferred

EXPERIENCE:
Minimum 3 years' experience, Required*

5+ years of experience, Preferred**

*Require minimum 3 years in a professional fee billing environment and/or physician practice operations.

**Prefer 5 + years in a medical/insurance environment for physician/professional billing revenue cycle.

Epic experience preferred.

LICENSURE/CERTIFICATION/REGISTRY/LISTING:
REQUIRED

PREFERRED

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