Employer job description

From Saint Luke's's posting. “We” and “our” refer to the employer.

Claim Edits

Responsible for researching patient billing claims to identify and correct coding/claim errors
Responsible for researching patient insurance coverage to identify and resubmit claims to fix coverage denials.
Research and outline documentation needed for respective payor organizations so that claims are processed correctly
Familiarity with NCCI edits, incidentals/inclusive, and bundling rules, etc.
Identify problem trends
Communicate with payors for resolution to complications with claims
Responsible for 277 EDI transactions/rejections
Working with EDI transactions
Payment posting corrections/adjustments and ability to distribute payments
Correct/enter charges
Work with multiple teams/departments to resolve issues
Payment plan or financial assistance coordination

Insurance Denials and Follow-Up

Responsible for researching, identifying errors, and correcting claims denied by insurance companies.
Must be able to asses claim to determine when appropriate to make charge adjustments, void a charge, or escalate to the team lead and/or another medical billing team.
Responsible for writing appeal letters to insurance companies
Responsible for following up with insurance companies for no response claims.
Responsible for working with patient calls escalated from the Customer Service team regarding involving billing code issues.
Research refund request from payor organizations
Responsible for preliminary audit of billing code errors before claim submitted to the Coding team.
Responsible for routing complex claim denial to team lead and/or the appropriate medical billing team.
Responsible for identifying issues which can be resolved by programing software to prevent denials.
Responsible for becoming a subject matter expert on the payor policies.
Responsible for communicating and resolving problems with the provider representatives

Patient Accounts Representative