Claims Follow Up Rep TC

Claims Processing Clerk

Under general supervision of the Claims Administration Follow-up Supervisor, perform all clerical duties necessary to properly process patient bills to customers taking appropriate follow-up steps to obtain timely reimbursement of each 3rd party claim and ensure the financial stability of the Hospital. 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:

• Consistently applies the corporate values of respect, honesty and fairness and the constant pursuit of excellence in improving the health status of the people of the region through the provision of customer-friendly, geographically accessible and high-value services within the environment of a comprehensive integrated academic health system.
• Responsible for knowing and acting in accordance with the principles of the Brown University Health Corporate Compliance Program and Code of Conduct.
• Review claim forms for all required data fields depending on the specific 3rd party requirements.
• Review patient account for demographic accuracy.
• Process all necessary system adjustments or changes as needed, such as adding/deleting insurance information, insurance priority changes, balance transfers, demographic changes, contractual allowances, and any other routine patient accounting adjustments not requiring supervisory approval ensuring accurate financial data.
• Analyze all assigned claims received from various sources to ensure accurate and timely reimbursement based on the individual payer's contracts or Federal reimbursement methods.
• Contact insurer via online systems, call centers, written correspondence, fax or appropriate electronic or paper billing of claims to secure payment.
• Maintains an understanding of the most current contract language in order to consistently ensure reimbursement in accordance with contract language.
• Continually maintains knowledge of payer specific updates via payer's listservs, provider updates, webinars, meetings and websites.
• Review payer's settlements for correct reimbursement and proceed with contact to insurer if claim is not adjudicated correctly based on working knowledge of the various payer's policies and each individual related contract.
• Identifies and analyzes denials and payment variances and enacts corrective measures as needed to effectively communicate and resolve payer errors.
• Understands and maintains compliance with HIPAA guidelines when handling patient information
• Initiate adjustments to payer's as appropriate after analyzing under or over payments based on contract, Federal regulation, late charge corrections or inappropriate denials.
• Submits appeals to payers as appropriate to recover denied revenue
• Contact internal departments to acquire missing or erroneous information on a claim resulting in adjudication delays or denials.
• Run reports as necessary to quantify various variances on patient accounts related to identified issues within the payers or as the result of known charging errors or procedural breakdown.
• Reports to supervisor identification of trends resulting in under/over payments, inappropriate denials or charging/billing discrepancies.
• Answer telephone inquiries from 3rd parties and interdepartmental calls.
• Refer all unusual requests to supervisor.
• Retrieve appropriate medical records documentation based on third party requests.
• Initiate the accurate and timely processing of all secondary and tertiary claims as needed according to specific 3rd party regulations.
• Process all incoming mail and follow up on all rejections received according to specific 3rd party regulations.
• Refer all accounts to supervisor for additional review if the account cannot be resolved according to normal patient accounting procedures.
• Works with supervisor, management and the patient accounting staff 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.

Work Locations/Expectations:

After orientation at the Corporate facilities, work is performed based on the following options approved by management and with adherence to a signed telecommuting work agreement and Patient Financial Services Remote Access Policy and Procedure. Full time schedule worked in office Full time schedule worked in a dedicated space in the home Part time schedule in office and in a dedicated space within the home Schedules must be approved in advance by management who will allow for flexibility that does not interfere with the ability to accomplish all job functions within the said schedule. Staff are required to participate in scheduled meetings and be available to management throughout their scheduled hours. Staff must be signed into Microsoft Teams during their entire shift and communicate with Supervisor as directed.

Minimum Qualifications:

Basic Knowledge: Equivalent to a high school graduate Knowledge of 3rd party billing to include ICD, CPT, HCPCS, UB and HCFA 1505 claim form 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 medical collections or professional/hospital billing preferred 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