Medical Billing Professional Denials Specialist

Claims Follow-Up Specialist

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 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.

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