Physician Billing Representative II

Denial Resolution Specialist

Responsible for reviewing, analyzing and initiating appropriate action for denial resolution by communicating with payers, medical practices, hospital departments and patients for data as assigned. Responsible for follow up with third-party insurance companies to resolve unpaid account balances. Focus on specialty payers including military, correctional facilities, assault victims and hospice.

Principal duties and responsibilities:

• Work accounts in assigned denial and no response work queues (WQs) to resolve uncollected account balances.
• Complete appropriate action needed for an effective resolution including conducting authorization research, rebilling, and balance write off or transfer to next responsible party. Escalates issues as appropriate.
• Perform follow-up with insurance carriers to obtain payment status and resolve claims issues within timely filing compliance.
• Reviews coverage changes made by other system users to determine if new or removed coverages, changed filing orders, or updated effective dates should be applied to previously billed, paid or adjusted charges in order to re-bill the charges.
• Assigns appropriate payer plans to facilitate billing and updates registration information when necessary.
• Reviews all encounter documents for completeness and proper CPT4/ICD10 coding as it relates to physician billing.
• Ensure claims have all necessary billing information.
• Meet departmental productivity benchmarks.
• Performs follow-up with insurance carriers to obtain payment status and resolve claim issues.
• Submits the appropriate documentation to third party payers to secure payment on claims.
• Reviews payment vouchers to ensure proper reimbursement.
• Resolves patient insurance discrepancies with office staff at physicians' offices.
• Review and submit claim forms to third party insurance companies timely.
• Performs assigned work safely, adhering to established departmental safety rules and practices; reports to supervisor, in a timely manner, any unsafe activities, conditions, hazards, or safety violations that may cause injury to oneself, other employees, patients and visitors.
• Performs other related duties as required.

Scope, purpose, and frequency of contacts:

Frequent contact with Christiana Care staff. Physician office staff, patients and third party payers.

Direction/supervision of others:

None.

Direction/supervision received:

Operations Coordinator and/or Billing Manager

Education and experience requirements:

• High school graduate or equivalent. Associate's degree preferred.
• Three to five (3-5) years of physician billing/coding experience preferably in a computerized physician billing department or large physician group practice, Epic experience preferred.
• An equivalent combination of experience and education may be substituted.
• Prior experience with and understanding CARC/RARC codes

Knowledge, skill, and ability requirements:

• Thorough understanding of revenue cycle process, from patient access (authorizations, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies.
• Knowledge of medical terminology.
• Knowledge of physician billing and reimbursement policies and procedures.
• Knowledge of CPT4 and ICD10 codes as it relates to physician billing.
• Knowledge of physician office practices.
• Ability to enter, update, and retrieve information using a personal computer.
• Skill in written and oral communication.
• Ability to act independently within established guidelines.
• Ability to exercise judgement and tact.

Special requirements:

None.

Physical demands:

Intermittent sitting, standing, and walking.

Light lifting and moving

Manual dexterity to initiate calls and provide computer entry.

Sight to dial numbers and read computer screens.

Working conditions:

Sits or stands most of the day in an office environment.

Hourly pay range: $22.74 - $34.11This pay rate/range represents ChristianaCare's good faith and reasonable estimate of compensation at the time of posting. The actual salary within this range offered to a successful candidate will depend on individual factors including without limitation skills, relevant experience, and qualifications as they relate to specific job requirements.

Christiana Care Health System is an equal opportunity employer, firmly committed to prohibiting discrimination, whose staff is reflective of its community, and considers qualified applicants for open positions without regard to race, color, sex, religion, national origin, sexual orientation, genetic information, gender identity or expression, age, veteran status, disability, pregnancy, citizenship status, or any other characteristic protected under applicable federal, state, or local law.