Provides daily management of claims processing and submission of third party claims. Performs regular and consistent follow up, denial management, correction and/or reprocessing claims as necessary to ensure timely resolution
Responsibilities/Job Description
Performs billing functions to review and take necessary actions to resolve billing errors ensuring clean claim submission
Performs charge corrections per departmental requests
Works directly with third party payers, internal and external customers, toward effective and efficient claims resolution
Responds to Customer Service inquires
Maintains a thorough knowledge of third party billing and collection requirements for payers assigned
Submits replacement, cancel, and appeal, claims to third party payers
Utilizes all resources available, including electronic inquiries to verify eligibility, and claim status
Exercises good judgement towards account resolution and documents all activity on account in clear, accurate, and consistent manner
Contacts patient for additional information in order to have claims processed and paid in a timely manner
Perform due diligence to contact patient by phone and/or sending a letter
Advises manager/coordinator of any billing errors, third party payer trends, denials, or payment fluctuation, to ensure proper handling and escalation when necessary
Meets departmental productivity and quality assurance standards in accordance with departmental policies
Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards
Actively participates in creating and implementing improvements
Performs other responsibilities as needed/assigned
Qualifications
REQUIRED
Three or more years experiencein an office clerical setting (preference of one or more years in a hospital or clinic business office.)
Additional Skills/Abilities:
ICD-9 10 Coding experience helpful
Attention to Detail: Achieves thoroughness and accuracy when accomplishing a task
Computer Skills Basic: Ability to use a computer and applications that are associated with performing basic work tasks (navigate in Windows, Outlook, etc)
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.
