Claims Follow Up Rep

Lifespan; Town of Providence (NY); On-site; USD 28,000 - 45,000; Full time

Job summary

Brown University Health seeks a detail-oriented Follow-up Claims Specialist in Providence, RI to review denied claims, correct entries, and resubmit corrected claims by mail, fax or electronic submission. Under supervision, you will help reduce denials and improve revenue cycle accuracy.

The ideal candidate has 1–3 years in professional billing, knowledge of ICD, CPT, HCPCS, and familiarity with Epic. You will collaborate with multiple departments while maintaining HIPAA compliance and quality

Qualifications

• Equivalent to a high school graduate.
• Knowledge of 3rd party billing including ICD, CPT, HCPCS, and 1500 forms.
• Strong critical thinking, diplomacy and relationship-building.
• Excellent communication skills with diverse teams.
• Problem-solving and inductive reasoning for operational efficiency.

Responsibilities

• Review all denied claims and correct them in the system.
• Identify denials and implement corrective measures.
• Stay updated on payer updates via lists, webinars, websites.
• Ensure HIPAA compliance when handling patient information.
• Coordinate with internal departments to obtain missing or erroneous claim information.
• Report denial trends to supervisor.
• Answer inquiries from 3rd party payers.
• Retrieve medical records as requested.
• Refer unresolved accounts to supervisor.
• Assist management to improve processes and efficiency.
• Maintain QA, safety, environmental and infection control.
• Perform other related duties.

Skills

Critical thinking

Diplomacy

Relationship-building

Communication skills

Education

High school diploma

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
  written correspondence, fax or via electronic submission.
• Identify and analyze denials and enact corrective measures as needed to effectively
  communicate and resolve payer errors.
• Continually maintain knowledge of payer specific updates via payer's listservs, provider
  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
  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
  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
  according to normal procedures.
• Work with management to improve processes, increase accuracy, create efficiencies and
  achieve the overall goals of the department.
• Maintain quality assurance, safety, environmental and infection control in accordance
  with established policies, procedures, and objectives of the system and
  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

Mon-Fri 7:30-4

Work Shift

Day

Daily Hours

8 hours

Driving Required

No