Bestcare
* Demonstrates active listening skills.* Notifies and keeps supervisor informed on denial and any other trends identified.* Follows telephone etiquette procedures set forth by the organization and/or individual department.* Professional/Courteous responses when communicating with customers, health system staff and management.* Can effectively communicate in meetings/forums to a large or medium group of individuals.* Works with supervisor to streamline process and decrease inefficiencies.* Demonstrates ability to learn and maintain a working knowledge on all the current health system applications.* Identify/obtain/print medical records as necessary for resolution of denial or system edits according to department guidelines.* Assists with testing and roll out plans to introduce new functionality within system applications used by the department.* Full understanding of all necessary third party payer appeals, billing and follow up guidelines including specific time frames and possible form filing requirements.* Leverages payer websites, automated tools and contract resources to streamline the follow up process.* Appropriate documentation in Source System when necessary.* Ability to interpret all appeal and follow up correspondence for accurate handling.* Can clearly identify, trend and articulate patterns and issues from provided denials data.* Can clearly provide alternative solutions with regards to denial findings.* Leverage all necessary denial data sources as needed for trending and analysis.* Leverage all necessary contract manager data sources and payer contracts as needed for reimbursement analysis.* Has the ability to effectively network and communicate with outside department, payers, patients and any other necessary resources to resolve denial issues timely.* Completion of any assigned projects timely, accurately and to the specifications of leadership.* Ability to articulate and communicate trend or other findings to various leadership personnel within the organization.* Ensure Daily/Weekly/Monthly assignments are handled accurately and timely.* High school diploma, General Educational Development (GED) or equivalent required* Coursework in Coding, Billing or Healthcare Management normally acquired through enrollment in a secondary education institution or online classes through the American Heath Information Management Association (AHIMA) preferred.* Demonstration of knowledge and practice in medical terminology, third party payer appeals, denial trending and analysis, ICD-9, ICD-10, CPT4/HCPCS Coding, UB04 and CMS1500 claim data as supported by the Patient Billing Rep Skill Set Examination required.* Minimum of 1-2 years experience in a healthcare business office setting operating patient accounting software, electronic billing software and/or accessing payer websites required.* Prior experience interpreting contractual language preferred.* Ability to create and submit both original and corrected claims.* Skill in interpreting UB04 and/or CMS1500 claim data to be able to troubleshoot claim edits and resolve payer billing requirements both timely and accurately.* Ability to audit accounts and payer explanation of benefits (EOBs) to determine appropriate action.* Ability to maintain a working knowledge of multiple system applications.* Ability to use effective communication skills in order to handle patient inquires, attorneys, health system staff and payers on a professional level.* Knowledge and understanding of accounting and business principles to enable accurate auditing of patient accounts.* Ability to follow up with the 3rd party payers for claims and appeals submitted to ensure timely and accurate processing.* Ability to review and clearly articulate denial trends and patterns to identify potential opportunity to prevent denials and maximize reimbursement.
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