Medical Billing Professional Denial Specialist

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

Job summary

Brown University Health in Providence, RI seeks a Claims Follow-Up Specialist to manage outstanding and denied claims across a large physician multi-specialty practice. Under general supervision, you will review denials, correct entries, and resubmit as needed to support timely revenue cycle performance.

You will stay current with payer updates, maintain HIPAA compliance, and coordinate with internal departments to obtain missing information.

Qualifications

• Equivalent to a high school graduate with knowledge of third-party billing including ICD, CPT, HCPCS, and 1500 forms.
• One to three years of relevant professional billing experience; Epic experience a plus.

Responsibilities

• Review denied claims, correct them in the system and resubmit corrected/appealed claims via written correspondence, fax, or electronic submission.
• Identify and analyze denials and implement corrective measures to resolve payer errors.
• Maintain knowledge of payer updates via listservs, provider updates, webinars, meetings and websites.
• Understand and maintain HIPAA compliance when handling patient information.
• Contact internal departments to obtain missing or erroneous information on a claim to prevent adjudication delays.
• Report denial trends to supervisor to identify revenue delays.
• Answer telephone inquiries from 3rd party payers and route unusual requests to supervisor.
• Retrieve requested medical records documentation based on third-party requests.
• Refer complex accounts to supervisor for additional review per procedures.
• Work with management to improve processes, increase accuracy, create efficiencies and achieve department goals.
• Maintain quality assurance, safety, environmental and infection control in accordance with policies.

Skills

Billing knowledge

HIPAA compliance

Communication skills

Problem solving

Attention to detail

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 asbr / written correspondence, fax or via electronic submission.
• Identify and analyze denials and enact corrective measures as needed to effectivelybr / communicate and resolve payer errors.
• Continually maintain knowledge of payer specific updates via payer’s listservs, providerbr / 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 claimbr / 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 tobr / supervisor.
• Retrieve appropriate medical records documentation based on third party requests.
• Refer all accounts to supervisor for additional review if the account cannot be resolvedbr / according to normal procedures.
• Work with management to improve processes, increase accuracy, create efficiencies andbr / achieve the overall goals of the department.
• Maintain quality assurance, safety, environmental and infection control in accordancebr / with established policies, procedures, and objectives of the system andbr / affiliates.
• Perform other related duties as required.

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