Claims Follow Up Rep

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 3rd party claim and ensure the financial stability of the
Hospital.

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/EXPECTIONS:

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.

Other information:

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

Brown University Health is an Equal Opportunity / Affirmative Action 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: Brown University Health Corporate Services USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union

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