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Inspire health. Serve with compassion. Be the difference. Job Summary Provides accurate and timely submission of claims for Prisma Health to various payer sources based on timely filing guidelines. Ensures specialty accounts are followed up on in a timely manner with increased focus on aged and high dollar accounts. Follows up and pursues identified payer variances after comparing expected to actual reimbursement received. Responsible for working with other departments when issues arise such as missing payments, payer delays, and technical denials. Ensures payment amount(s) from insurance carriers are correct and posted to accounts. Reviews accounts after payment posting to determine if balance needs moved to secondary payer or patient liability. Knowledge of payers and provides support to other team members as needed. Demonstrates exceptional relationships with external payers and internal departments in accordance with Prisma Health Standards of Behavior and Compliance.
Accountabilities
Works and processes the Billing functions, including resolving the Discharged Not Final Billed/Stop Bill\u00A0 errors that prevented the account from billing, the resolution of Claim Edits in order to submit to our Claims Clearinghouse for electronic submission. Also processes the daily paper claims submissions for primary and secondary claims. - 30% Follows up on Specialty AR accounts assigned to determine if the claim has been accepted and processed for payment or denied. Reviews claim rejections and re-bills accounts when appropriate.\u00A0 Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient and Prisma Health departments to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered. - 25% Escalates accounts both at the payer and/or internally when appropriate, as well as involving the patient appropriately in accordance with the Prisma Health escalation guidelines in order to keep AR aging at acceptable levels for payer issues. - 10% Identify system issues through trending and repetitive actions that require workflow review or changes to resolve compliant billing. - 5% Utilize proper tools to communicate with Prisma Health department teams on specific errors for corrections\u00A0 related to their area of responsibility. - 5% Contacts insurance payers, patients or guarantors at established intervals to follow-up on status of delinquent accounts, determines the reason of delay and expedites payment. - 5% Must meet daily performance productivity and quality goals.\u00A0 Is attentive to detail and accuracy, is committed to excellence, looks for improvements continuously, monitors quality levels, finds root cause of quality problems and owns/acts on quality problems.\u00A0 Actively contributes to department goals.\u00A0 Effectively utilizes time and resources, assisting co-workers as time allows.\u00A0 Must be dependable. - 5% Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field\u00A0 of expertise. - 5% All policies and procedures will be strictly adhered to.\u00A0 HIPAA, security, dress code, etc. will be conscientiously followed.\u00A0 Understands, promotes and adheres to all matters of compliance with laws and regulations.\u00A0 High level demonstration of the Standards of Behaviors. - 5% Communicates well both verbally and in writing, shares information with others & has good listening skills. - 5%
Supervisory/Management Responsibilities
- This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- High school diploma or equivalent. \u200B
- 3 years - hospital claims and billing follow-up; understanding of the hospital and physician claim forms, knowledge of payer guidelines. \u200B
Required Certifications/Registrations/Licenses
In Lieu Of The Minimum Requirements Listed Above
- Bachelor's degree and 2 years of hospital billing, follow-up/denials. \u200B
Other Required Sills and Experience
- Facility claims and\u00A0billing follow up and/or medical office experience - required.
- Communication skills and respect for details - preferred.
- CRCA or CRCR - preferred.
\u200B Work Shift Day (United States of America)
Location 1200 Colonial Life Blvd
Facility 7001 Corporate
Department 70019012 Patient Account Services
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Prisma Health
October 07, 2023