The following section contains representative examples of job duties that might be performed in positions allocated to this job class. Union General Health System is a dynamic organization, and the environment can be fluid. Roles and responsibilities may be altered to accommodate changing business conditions and objectives as well as to tap into the skills and experience of its employees. Accordingly, employees may be asked to perform duties that are outside the specific work that is listed. It is not required that any position perform all duties listed, so long as the primary responsibilities are consistent with the work as described. Performance standards developed for incumbents allocated to this job class may also contain relevant job content information and are referenced hereto.

• Conducts root-cause analysis of all assigned insurance payer claims to determine appropriate actions required to resolve the claim to a paid status.
• Communicates effectively over the phone and through written correspondence to explain outstanding balances, denials and/or underpaid claims using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements.
• Corrects identified billing errors and resubmits claims with necessary information through paper or electronic methods.
• Anticipates potential areas of concern; identify issues/trends and provides feedback to Insurance Supervisor / Director.
• Recognizes when additional assistance is needed to resolve claim issues / denials and escalates appropriately and timely through defined communication and escalation channels.
• Resolves work queues according to the prescribed priority and/or per the direction of the Insurance Supervisor and in accordance with policies, procedures and other job aides.
• Organizes open accounts to quickly address in bulk with representatives over the phone, via spreadsheet or utilizing an on-line payer portal, etc.
• Documents all activities and findings in accordance with established policies and procedures; ensures the integrity of all account documentation; maintains confidentiality of medical records.
• Uses critical thinking skills and payer knowledge to recommend system edits to reduce denials and result in prompt and accurate payment.
• Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding.
• Communicates with insurance supervisor and staff regarding insurance carrier contractual and regulatory requirements that impact payment and denials.
• Meets quality assurance and productivity standards for timely and accurate claim resolution in accordance with organizational policies and procedures.
• Increases and maintains current knowledge of internal, industry, and government regulations as applicable to assigned function. Understands detailed billing requirements, denial reason codes, and insurance follow-up practices.
• Understands government and commercial insurance reimbursement terms, contract language, and appropriate reimbursement amounts.
• Has knowledge of, and is compliant with, government regulations including "signature on file" requirements, compliance program, HIPAA, etc.
• Establishes and maintains professional and effective relationships with peers and other stakeholders.
• Works collaboratively with payers and revenue cycle staff to explain denial or underpayment issues.
• Establishes and maintains a professional relationship with all Union General Health System staff to resolve issues.
• Promotes an atmosphere of collaboration so peers feel comfortable approaching with issues and challenges specific to their payer or specialty.
• Depending on role and training, may be called upon to support other areas in the Revenue Cycle.
• Performs related duties as required.

• High School Diploma or GED equivalent is required.
• Graduate from a post-high school program in medical billing or other business-related field is preferred.

• Hospital and/or physician billing and accounts receivable management experience is preferred.

• Basic knowledge of medical insurance, payer contracts, and medical terminology / abbreviations is preferred

• Working knowledge of Microsoft Office products, specifically Excel
• Understanding of HIPAA regulations and proven ability to ensure confidentiality with respect to protected health information.

• Strong interpersonal abilities, including good written and verbal communication skills to clearly document issues and effectively communicate.

• Ability to gain cooperation and support from a diverse body of individuals
• Highly dependable in both production and attendance
• Basic organizational, problem solving, and time management skills with attention to detail.
• Ability to effectively prioritize and execute tasks while under pressure; make decisions based on available information and within the scope of authority of the position; excellent customer service skills, including professional telephone interactions.

• Good keyboarding skills