Billing Follow Up Representative I - Behavioral Health

Advocate Aurora Health; United States; Remote; USD 40,000 - 55,000; Full time

Job summary

A leading healthcare organization is seeking a Billing Operations Specialist to manage insurance claims and ensure maximum reimbursement. The role involves reviewing accounts, communicating with payors, and maintaining performance indicators. This position offers a flexible remote work schedule and requires a high school diploma with relevant experience.

Qualifications

• Typically 1 year of related experience in a medical billing/reimbursement environment.
• Proficient in reading, writing, and understanding English.

Responsibilities

• Review accounts and apply billing follow-up knowledge for insurance payors.
• Communicate with internal teams and external customers regarding claims.
• Maintain KPI for assigned payers within established standards.

Skills

Communication

Independence

Attention to Detail

Education

High School Diploma or GED

Tools

Medical Terminology

CPT

ICD-10

HCPCS

Job description

Department:

10324 Enterprise Revenue Cycle - WI Special Program Billing Operations

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

• Flexible first shift with start times of 7:00am, 7:30am, or 8:00am
• This is a REMOTE Opportunity

MAJOR RESPONSIBILITIES

• Independently review accounts and apply billing follow-up knowledge required for all insurance payors to ensure proper and maximum reimbursement. Use multiple systems to resolve outstanding claims according to compliance guidelines.
• Perform prebilling, billing, and follow-up activities on open insurance claims, utilizing revenue cycle knowledge (e.g., CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology). Obtain necessary documentation from various resources.
• Communicate timely and accurately with internal teams and external customers (e.g., third-party payors, auditors, other entities). Act as a liaison with external third-party representatives to validate and correct information.
• Understand incoming insurance correspondence and respond appropriately. Identify and report patterns/trends to leadership related to coding, compliance, contracting, claim form errors, and credentialing that could delay or deny reimbursement. Stay updated on insurance payer updates/changes, single case agreements, and assist management with recommendations for implementing edits/alerts.
• Enter and update patient/insurance information accurately into the patient accounting system. Appeal claims to ensure contracted amounts are received from third-party payors.
• Maintain KPI (Key Performance Indicators) for assigned payers within established standards and insurance guidelines.
• Compile information for referral of accounts to internal/external partners as needed. Document all billing and follow-up activities clearly and accurately, using established guidelines.
• Read and understand all Advocate Aurora Health policies and departmental collection policies and procedures. Demonstrate proficiency in the use of employed software systems.
• Refer issues outside normal scope of activity to the supervisor for approval or final disposition, such as recommendations regarding handling of unusual/unreasonable/inaccurate account information or write-offs according to corporate policy.

MINIMUM EDUCATION AND EXPERIENCE REQUIRED

• High School Diploma or GED
• Typically 1 year of related experience in a medical billing/reimbursement environment, or equivalent combination of education and experience.

MINIMUM KNOWLEDGE, SKILLS, AND ABILITIES

• Work within departmental productivity and quality standards.
• Work independently with limited supervision.
• Accountable to organizational behaviors of excellence.
• Basic keyboarding proficiency and ability to operate computers and software systems used at Advocate Aurora Health.
• Operate office equipment such as copy machines, fax machines, telephones, and voicemails.
• Proficient in reading, writing, speaking, and understanding English.
• Ability to interpret documents like EOBs, operating instructions, and manuals.
• Preferred but not required: knowledge of medical terminology, coding (CPT, ICD-10, HCPCS), and insurance/reimbursement practices.
• Effective communication skills for obtaining basic information via telephone or in person.

This job description provides a general overview of the role. Additional related duties may be assigned as needed.