About this role
MAJOR FUNCTION:
Ensures that all charges billed are paid accurately and within the required time parameters by identifying and taking the required steps to investigate and resolve payment denials and other payment issues.
QUALIIFCATIONS:
Education & Experience:
- High School diploma or equivalent required.
- 1-2 years medical physician billing or collections required.
Certification/Licensure:
- AHIMA Certified Coder, AAPC Certified Coder, or coding experience a plus.
Knowledge & Skills:
- Knowledge of Windows-based software applications (Word, Excel, etc.).
Position Responsibilities
• Investigates and takes the appropriate steps to address and resolve payment denials and
incorrectly paid accounts.
• On a daily basis, reviews the denial que and researches and resolves these claims issues
contacting the pertinent parties by telephone or insurance website.
• Reviews the que on a daily basis to capture "no response" claims and to follow-up or reexamine claims "with response" at least every 30 days until the account is resolved
appropriately.
• Identifies practice and/or payer-specific trends that cause an increase in the A/R aging
and works with leadership to resolve.
• Reviews Revenue Manager for claim rejections (or claim edits) – electronic claims that are
flagged for incorrect or invalid information on the original electronic claim. Determines
reason for rejection and identifies claim form locators causing the errors. Corrects
information submitted internally causing the rejection and resubmits claim. Escalates
issues to supervisor that require further investigation.
• Updates Cerner Millenium with notes to reflect account status and collection activity.
• Provides timely communication to leadership with regards to payer issues and updates.
| Physical Requirements: N: Never O: Occasionally (<20%) F: Frequently (20%-80%) C: Constantly (>80%) | |||||
| Lifting <20lbs | O | Standing | O | Sitting | C |
| Lifting 20-50lbs | N | Climbing | N | Kneeling | N |
| Lifting>50lbs | N | Crouching | N | Reaching | O |
| Carrying | O | Hearing | C | Walking | O |
| Pushing | N | Talking | C | Vision | C |
| Environmental Conditions: | |||||
| Noise | N | Varied Temperatures | O | Cleaning Agents | N |
| Noxious odors | N | Patient Exposure | N | Operative Equipment | N |
Other facts
About Inspira Health
Inspira Health is a charitable nonprofit health care organization serving communities across southern New Jersey. The system traces its roots to 1899 and comprises three hospitals, two comprehensive cancer centers, eight multi-specialty health centers, and locations throughout South Jersey. These include urgent care; outpatient imaging and rehabilitation; sleep medicine labs; cardiac testing facilities; behavioral health, digestive health and wound care centers; home care and hospice; and more than 35 primary and specialty physician practices in Gloucester, Cumberland, Salem, Camden and Atlantic counties.
Together with our medical staff of more than 1,200 physicians and other health care providers, we provide evidence-based care to help each patient achieve the best possible outcome. Our clinical and support staffs are focused on providing quality care in a safe environment for every patient. And we understand that to provide excellent care to our patients, we must also be sensitive to the needs of their families. The love and support of family can comfort and strengthen patients while aiding the healing process.
In support of our mission to improve the lives of all we serve, the leadership and staff of Inspira Health are dedicated to clinical and service excellence. However, as a leading regional health network, we are committed to doing more than just that. We believe our organization must become a source of inspiration, encouraging everyone to lead healthier lives. This can only be achieved by working together with our communities; by bringing vital services to the towns and neighborhoods we serve; and partnering with like-minded organizations to create a culture throughout our region that fosters good health for everyone.
What you'll do
- The Accounts Receivable Rep investigates and resolves payment denials and issues related to billing. They review claims daily, follow up on outstanding accounts, and communicate with leadership regarding payer issues.
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