Claims Follow Up Rep

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.

Responsibilities:

Review all denied claims, correct them in the system and send corrected/appealed 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.

Other information:

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

Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services, USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union