Claims Follow Up Rep

Brown University Health; Providence (RI); On-site; USD 28,000 - 45,000; Full time

Job summary

Brown University Health in Providence, RI seeks a follow-up claims specialist to manage outstanding claims and correct denied claims for a large physician multi-specialty practice.

The role involves reviewing denials, communicating with payers, ensuring HIPAA compliance, and collaborating with internal departments to expedite adjudication. Monday–Friday, on-site at Corporate Headquarters.

Qualifications

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing including ICD, CPT, HCPCS and 1500 forms.
• Demonstrated skills in critical thinking, diplomacy and relationship-building.
• Strong communication skills with diverse teams.
• Experience with Epic is a plus.

Responsibilities

• Review denied claims and correct them in the system; send corrected/appealed claims via written correspondence, fax or electronic submission.
• Identify and analyze denials; enact corrective measures to resolve payer errors.
• Stay updated on payer updates via lists, provider updates, webinars and websites.
• Maintain HIPAA compliance when handling patient information and gather missing information.
• Report denial trends to supervisor and assist in process improvements.
• Answer inquiries from 3rd party payers via phone; refer unusual requests to supervisor.
• Refer unresolved accounts to supervisor for further review.

Skills

ICD/CPT/HCPCS knowledge

Communication skills

Critical thinking

Relationship-building

Inductive reasoning

Education

High school diploma

1–3 years professional billing experience

Tools

Epic

Job description

Summary

Under general supervision of the Follow-up Supervisor, performs all duties necessary to follow up on outstanding claims and correct all denied claims for a large physician multi-specialty practice. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences Patient and Community Focus and Collaborate

Responsibilities

Review all denied claims, correct them in the system and send correctedppealed claims as br / written correspondence, fax or via electronic submission. Identify and analyze denials and enact corrective measures as needed to effectively br / communicate and resolve payer errors. Continually maintain knowledge of payer specific updates via payer’s listservs, provider br / updates, webinars, meetings and websites. Understand and maintain compliance with HIPAA guidelines when handling patient information Contact internal departments to acquire missing or erroneous information on a claim br / resulting in adjudication delays or denials. Report to supervisor identification of denial trends resulting in revenue delays. Answers telephone inquiries from 3rd party payers; refer all unusual requests to br / supervisor. Retrieve appropriate medical records documentation based on third party requests. Refer all accounts to supervisor for additional review if the account cannot be resolved br / according to normal procedures. Work with management to improve processes, increase accuracy, create efficiencies and br / achieve the overall goals of the department. Maintain quality assurance, safety, environmental and infection control in accordance br / with established policies, procedures, and objectives of the system and br / affiliates. Perform other related duties as required.

Minimum Qualifications

Basic Knowledge

Equivalent to a high school graduate. Knowledge of 3rd party billing to include ICD, CPT, HCPCS and 1500 claim forms. Demonstrated skills in critical thinking, diplomacy and relationship-building. Highly developed communication skills, successfully demonstrated in effectively working with a wide variety of people in both individual and team settings. Demonstrated problem-solving and inductive reasoning skills which manifest themselves in creative solutions for operational inefficiencies.

Experience

One to three years of relevant experience in professional billing preferred. Experience with Epic a plus.

Independent Action

Incumbent generally establishes own work plan based on pre-determined priorities and standard procedures to ensure timely completion of assigned work. Problems needing clarification are reviewed with supervisor prior to taking action.

Supervisory Responsibility

None

Pay Range

$19.97-$32.96

EEO Statement

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type

Monday-Friday 7:30-4

Work Shift

Day

Daily Hours

8 hours

Driving Required

No