| The Claim Specialist II monitors the volume and accuracy of Pro Fee claims and revenue cycle processes by monitoring work queues for increased volume of rejections, denials or other unfavorable trends. Working under general supervision, this role performs insurance outstanding AR follow up and analyzes results to identify if issues are user related, system related or payer related, as well as communicates identified issues that may improve efficiency and maximize the accuracy of claims submissions. |
| Performs timely claims processes and insurance follow up activities according to policy for payments. Ensures that all Revenue Cycle services are delivered in full compliance with State and Federal regulations, organizational policies, and accreditation/compliance requirements and adheres to regulatory standards, including Corporate Compliance and Health Insurance Portability and Accountability Act (HIPAA), while staying current through continuous education and in-services to uphold the hospital's compliance standards. Communicates incomplete or inaccurate information originating from the front-end and back-end functions of billing and follows-up to ensure that data discrepancies are addressed promptly, leading to improved billing accuracy and efficiency. Reviews end users' issues, workflow problems and provides updates to team leaders of identified issues and trends. Analyzes issues and effectively communicates to leadership and other teams cause, effect, and solutions to eliminate errors or negative impact trends. Assures timely response to third party payers? requests for additional information in addition to claims follow up for denials and no response. Performs other duties as assigned. |
| EDUCATION: |
| Required: High School Diploma or equivalent |
| EXPERIENCE: |
| Required: 3 years |
| LICENSURE/CERTIFICATION/REGISTRY/LISTING: |
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