Claims Follow Up Rep

Claims Follow-Up and Denials Specialist

Under general supervision of the PFS Supervisor of Claims Follow-up and Denials, performs all duties necessary to properly follow up on outstanding claims and correct/re-process all denied claims to obtain timely reimbursement of each third-party claim and ensure the financial stability of a large multi-specialty, multi-state physician 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 (primary, secondary, tertiary), correct them in the system and send corrected/appealed claims to third party payers to result in reimbursement for services performed.
• Resolve all outstanding claims (whether the payer has responded or not), underpaid claims and overpaid claims.
• Identify and analyze denials and enact corrective measures as needed to effectively communicate and resolve errors and ensure timely and accurate reimbursement.
• Understand and maintain compliance with HIPAA guidelines when handling patient information.
• Contact internal departments/patients to acquire missing or erroneous information on a claim.
• Identify denial trends resulting in revenue delay and report to supervisor.
• Follow department policies and procedures pertaining to workflows, assignments and adjustments.
• Contact third party payers and answer their inquiries.
• Retrieve appropriate medical record documentation based on third party requests.
• Research payer policies and ensure claims meet those payer policies.
• Thoroughly master the nuances of assigned specialties.
• Perform other related duties as required.

Working Conditions:

Position can be fully remote, hybrid or in-office. Manager will approve work arrangements.

Minimum Qualifications:

Basic Knowledge:

• Equivalent to a high school graduate.
• Knowledge of third party billing, including 1500 claim forms, CPT and ICD-10.
• Excellent verbal and written communication skills.
• Technical proficiencies to include Microsoft Excel, Outlook and Teams applications.
• Demonstrated problem solving skills.

Experience:

• One to three years of relevant experience in insurance follow-up of professional/hospital billing.
• Experience with Epic preferred.

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: BHCS 15 LaSalle Square - 15 LaSalle Square Providence, Rhode Island 02903

Work Type: 7:30 am - 4:00 pm

Work Shift: Day

Daily Hours: 8 hours

Driving Required: No