Brown University Health
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PFS AR Insurance Follow-up
role at
Brown University Health
SUMMARY 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 third‑party claim and ensure the financial stability of the hospital. Employees are expected to role‑model the organization's values and principles of compliance.
RESPONSIBILITIES
Review claim forms for required data fields based on third‑party requirements and patient account accuracy.
Process system adjustments: add/delete insurance, priority changes, balance transfers, demographic changes, contractual allowances.
Analyze assigned claims and ensure accurate, timely reimbursement according to payer contracts or federal methods.
Contact insurers via online systems, call centers, written correspondence, fax, or electronic billing to secure payment.
Maintain knowledge of current contract language and payer specific updates through listservs, provider updates, webinars, meetings, and websites.
Review payer settlements for correct reimbursement; contact insurer if claim is not adjudicated correctly.
Identify and analyze denials and payment variances, enact corrective measures, and communicate to resolve payer errors.
Initiate adjustments for under/over payments, late charge corrections, or inappropriate denials.
Submit appeals to payers to recover denied revenue.
Coordinate with internal departments for missing or erroneous information that delays adjudication.
Run reports to quantify variances and identify billing discrepancies, reporting trends to supervisor.
Answer telephone inquiries from third parties and internal calls; refer unusual requests to supervisor.
Retrieve appropriate medical records documentation based on third‑party requests.
Process secondary and tertiary claims per third‑party regulations and follow up on rejections.
Refer accounts to supervisor for additional review when they cannot be resolved normally.
Collaborate with supervisor, management, and patient accounting staff to improve processes, increase accuracy, and achieve departmental goals.
Maintain quality assurance, safety, environmental, and infection control policies.
Perform other related duties as required.
QUALIFICATIONS
High school graduate or equivalent.
Knowledge of third‑party billing, including ICD, CPT, HCPCS, UB, and HCFA 1505 claim form.
Demonstrated critical thinking, diplomacy, relationship‑building, communication, and problem‑solving skills.
One to three years of relevant experience in medical collections or professional/hospital billing (preferred).
Ability to develop own work plan, prioritize tasks, and seek clarification when needed.
WORK LOCATIONS / EXPECTATIONS After orientation, work may be performed at the corporate facility or remotely under a signed telecommuting agreement. Options include full‑time in office, full‑time remote, or part‑time hybrid. Employees must attend scheduled meetings, be available during hours, and stay signed into Microsoft Teams. Work schedule details will be approved in advance by management.
PAY RANGES $19.58-$32.31 per hour
EEO STATEMENT Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.
LOCATION BHCS 15 LaSalle Square, Providence, Rhode Island 02903
SENIORITY LEVEL Entry level
EMPLOYMENT TYPE Full‑time
JOB FUNCTION Accounting / Auditing and Finance; Hospitals and Health Care
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PFS AR Insurance Follow-up
role at
Brown University Health
SUMMARY 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 third‑party claim and ensure the financial stability of the hospital. Employees are expected to role‑model the organization's values and principles of compliance.
RESPONSIBILITIES
Review claim forms for required data fields based on third‑party requirements and patient account accuracy.
Process system adjustments: add/delete insurance, priority changes, balance transfers, demographic changes, contractual allowances.
Analyze assigned claims and ensure accurate, timely reimbursement according to payer contracts or federal methods.
Contact insurers via online systems, call centers, written correspondence, fax, or electronic billing to secure payment.
Maintain knowledge of current contract language and payer specific updates through listservs, provider updates, webinars, meetings, and websites.
Review payer settlements for correct reimbursement; contact insurer if claim is not adjudicated correctly.
Identify and analyze denials and payment variances, enact corrective measures, and communicate to resolve payer errors.
Initiate adjustments for under/over payments, late charge corrections, or inappropriate denials.
Submit appeals to payers to recover denied revenue.
Coordinate with internal departments for missing or erroneous information that delays adjudication.
Run reports to quantify variances and identify billing discrepancies, reporting trends to supervisor.
Answer telephone inquiries from third parties and internal calls; refer unusual requests to supervisor.
Retrieve appropriate medical records documentation based on third‑party requests.
Process secondary and tertiary claims per third‑party regulations and follow up on rejections.
Refer accounts to supervisor for additional review when they cannot be resolved normally.
Collaborate with supervisor, management, and patient accounting staff to improve processes, increase accuracy, and achieve departmental goals.
Maintain quality assurance, safety, environmental, and infection control policies.
Perform other related duties as required.
QUALIFICATIONS
High school graduate or equivalent.
Knowledge of third‑party billing, including ICD, CPT, HCPCS, UB, and HCFA 1505 claim form.
Demonstrated critical thinking, diplomacy, relationship‑building, communication, and problem‑solving skills.
One to three years of relevant experience in medical collections or professional/hospital billing (preferred).
Ability to develop own work plan, prioritize tasks, and seek clarification when needed.
WORK LOCATIONS / EXPECTATIONS After orientation, work may be performed at the corporate facility or remotely under a signed telecommuting agreement. Options include full‑time in office, full‑time remote, or part‑time hybrid. Employees must attend scheduled meetings, be available during hours, and stay signed into Microsoft Teams. Work schedule details will be approved in advance by management.
PAY RANGES $19.58-$32.31 per hour
EEO STATEMENT Brown University Health is an Equal Opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, ethnicity, sexual orientation, ancestry, genetics, gender identity or expression, disability, protected veteran, or marital status. Brown University Health is a VEVRAA Federal Contractor.
LOCATION BHCS 15 LaSalle Square, Providence, Rhode Island 02903
SENIORITY LEVEL Entry level
EMPLOYMENT TYPE Full‑time
JOB FUNCTION Accounting / Auditing and Finance; Hospitals and Health Care
#J-18808-Ljbffr