Job Summary:

Demonstrates through behavior Decatur Morgan Hospital’s mission, vision and values. Billing Insurance Follow Up Specialist is responsible to monitor their assigned payers and follow up on unpaid claims or claims identified within the at-risk claims work queue. To promptly resolve and resubmit those claims back to appropriate billers at CBO. The IBF Specialist is responsible for working payer denial and incorrect payments and resolving issues with unpaid claims. The IBF Specialist will also work credit balances and process refunds with communication with our CBO both insurance and patient.

Key Responsibilities / Essential Functions

1. Initiates follow up procedures on unpaid claims within defined timeline to ensure timely payment is received. Contact insurance companies to obtain claim status, resolve denials, and secure payment.
2. Collaborate with coding, patient access, and billing departments to resolve claim issues
3. Communicates repetitive or unusual errors to manager and/or others to resolve problematic actions or activities which may be user or system driven affecting clean claim accuracy.4Research claim edits, coding issues, authorization requirements, and filing deadlines
4. Responds to payer requests for additional information timely in order to facilitate claim processing and payment. Submit corrected claims recommendations to Central Business Office to correct.
5. Work aging reports and prioritize accounts based on timely filing and reimbursement opportunities
6. Reviews payer specific remittances to analyze and make corrections in order to re-bill/appeal or internally adjudicate claims in response to denials. Utilizes knowledge and experience to ensure appropriate reimbursement is obtained and appropriate adjustments are processed.
7. Submit transaction adjustments as may be necessary as supported by remittance documentation. Processes payment posting timely electronic and manually as necessary.
8. Applies notes to individual patient accounts that are informative, concise and facilitates corrected account resolution.
9. Maintain productivity and quality standards established by the department.
10. Review and process credit balances as appropriate to insurance or guarantor.

Minimum Knowledge, Skills, Experience Required:

Education:  High School Diploma, GED required. Medical billing certification desirable

Experience: Minimum of 1–2 years of hospital business office or healthcare insurance follow-up experience required

Knowledge of Medicare, Medicaid, commercial insurance, and managed care payers Experience working hospital accounts receivable and insurance denials preferred

Familiarity with healthcare billing systems such as Meditech, preferred, Strong analytical, organizational, and communication skills, Ability to work independently and manage multiple accounts effectively, Proficient computer and data entry skills