Billing Claims Specialist II

3 weeks ago


Oak Brook, Illinois, United States Advocate Health Full time
Job Summary

As a Billing Claims Specialist II at Advocate Health, you will be responsible for daily claims submissions to the appropriate responsible parties. You will act as a resource person, assisting teams with more complex issues, and work with team members to facilitate problem resolution and provide training. You may be involved in quality audit processes, productivity, and special projects as assigned. You will use multiple systems to resolve outstanding claims according to compliance guidelines.

Key Responsibilities:

* Prebilling/billing and follow-up activity on open insurance claims, exercising revenue cycle knowledge (CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology)
* Obtain necessary documentation from various resources
* Ability to timely and accurately communicate with internal teams and external customers (third-party payors, auditors, and other entities) via phone or mail and act as a liaison with external third-party payer representatives to validate and correct information and ensure regulatory and contractual compliance
* Comprehend incoming insurance correspondence and respond appropriately
* Identify and bring patterns/trends to leadership's attention (coding and compliance, contracting, claim form edits/errors, and credentialing for any potential delay/denial of reimbursement)
* Obtain and keep abreast with insurance payer updates/changes, single-case agreements, and assist management with recommendations for implementation of any edits/alerts
* Accurately enter and/or update patient/insurance information into patient accounting systems
* Appeals claims to assure contracted amount is received from third-party payors
* Comply and maintain KPI (Key Performance Indicators) for assigned payers within standards established by department and insurance guidelines
* Compile information for referral of accounts to internal/external partners as needed
* Compile and maintain clear, accurate, on-line documentation of all activity relating to billing and collection efforts for each account, utilizing established guidelines

Requirements:

* High School Diploma or General Education Degree (GED)
* Typically requires 2 years of related experience in medical/billing reimbursement environment, or equivalent combination of education and experience
* Basic keyboarding proficiency
* Ability to operate computer and software systems in use at Advocate Health
* Ability to read, write, speak, and understand English proficiently
* Ability to read and interpret documents such as explanation of benefits (EOB), operating instructions, and procedure manuals
* Knowledge of medical terminology, coding, terminology (CPT, ICD-10, HCPCS), and insurance/reimbursement practices
* Ability to problem solve complex billing, coding, and contract issues
* Proficient knowledge base and understanding of department-specific policies and procedures
* Strong analytic, organization, communication (written and verbal), and interpersonal skills

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities required of the incumbent. The incumbent may be required to perform other related duties.

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