Responsible for assisting the revenue cycle team by performing one or more aspects of routine physician revenue cycle billing. Communicate and work with University and UCM departments, patients, payers and other external entities to obtain the necessary information to process claims, collect cash and reduce AR.
Oversees the AR follow-up and denial resolution process with minimal direct oversight while also proactively reviewing current workflows for AR resolution with the intent to improve, implement, communicate and maintain an efficient AR resolution process.
Identifies and resolves the systematic and/or operational root causes of denials and outstanding AR. Oversees and manages the AR follow-up work queues (WQ) and proposes both short and long-term enhancements that support business needs.
Assists manager with maintaining payer scorecards, creating payer meeting agendas, and communicating issues to provider representatives.
Works with the payers on escalated account resolution, identifies and submits high-complexity and other escalated payer projects, proactively reviews payer communication, initiates payer policy and rule change implementation, and proposes changes to front-end or back-end edits.
Creates simple to moderately-complex reports that are necessary for payor projects using a variety of business tools.
Communicates clearly and professionally with the other UCPG units, clinical departments, external vendors, and payers in order to build partnerships that result in denial resolution and prevention.
Provides AR follow-up expertise to other UCPG and UCM business units as needed. Works closely with the Coding Education team to suggest opportunities for coder and provider training.
Assists clinical departments in resolving escalated AR and denial issues. Works with Hospital Billing (HB) team on AR issues that cross between PB, HB, or SBO applications.
Provide AR follow-up training to existing and new AR follow-up staff.
Complete quality audits for denial and AR resolution activities.
Create denial Appeal, Reconsideration, and Medical Necessity letter templates and trains staff in effectively using these templates.
Create workflows and assists manager in developing and documenting policies and procedures.
Proven ability to effectively develop and introduce procedures and processes to others both within Department and with Manager/individuals in other UCM departments is required.
Demonstrated ability to participate as a member of a work group or team is required.
Demonstrated ability to set priorities and to effectively manage completion of assigned duties, with minimal supervision is required.
Demonstrated ability to communicate effectively in English, both orally and in writing is required.
Education, Experience or Certifications:
High School diploma required.
Degree in business, finance, administration, or related field preferred.
Background with physician revenue cycle specific AR follow-up and denial resolution required.
Working knowledge using physician billing/revenue cycle software and electronic medical records systems required.
Proficient with physician revenue cycle specific AR follow-up and denial resolution required.
Accomplished in diagnosis and CPT coding terminology required.
Skillful in charge correction activities required.
Licenses and Certifications:
Diagnosis and CPT coding terminology required.
Charge correction activities required.
Technical Knowledge or Skills:
Critical thinking skills to review/compare information and form conclusions is required.
PC experience and MS Office (Word, Excel, PowerPoint) required.
Demonstration of effective interpersonal skills necessary to develop effective working relationships with both internal and external customers is required.
Professional References Contact Information (3)
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Internal Number: JR10520
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