Job Description

POSITION SUMMARY:

The Billing, Claims & Reimbursement Specialist is responsible for a portfolio of insurance accounts receivable and is engaged in proactive billing and collection of outstanding balances, including accurate and timely filing of claims and processing of appeals, with government or third-party payors. The Claims & Reimbursement Specialist will ensure correct and appropriate information is on a claim and will promptly handle resolution of outstanding balances, which involves working with UW Health Northern Illinois internal and external customers (e.g. third party payers, estate representatives, attorneys, clinicians, employers, and UW Health Northern Illinois employees). Additionally, this position requires a thorough understanding of often complex contracts, third party payer requirements, government regulations, and in-house computer applications for billing and accounts receivable.

This position represents UW Health Northern Illinois and the Revenue Cycle team by adhering and upholding the UW Health Respect for People Commitments and UW Health Northern Illinois Service Excellence Standards of Behavior in providing the highest quality service to our customers. They will be friendly, knowledgeable, flexible, and reliable. They will listen to, anticipate, recognize, and satisfy our customer\'s needs. We will improve our collections while ensuring the highest level of satisfaction, keeping our promises and commitments, and demonstrating our commitment through respect, knowledge, responsiveness, and courtesy. They will support their co-workers, engage in positive interactions, demonstrate friendliness by smiling and making eye contact when greeting all customers, provide helpful assistance in anticipating and responding to the needs of our customers and staying calm under pressure to deal effectively with difficult people.

EDUCATION/TRAINING:

High school diploma or GED preferred. At least 2 years experience in healthcare or related filed with emphasis on insurance billing and insurance claim follow-up processes.

EXPERIENCE/SKILLS/ABILITIES:

• Excellent customer service, interpersonal and organizational skills
• Ability to use good judgments in demanding situations
• Ability to react to frequent changes in duties and volume of work
• Effective communication skills
• Ability to listen empathetically
• Ability to logically and accurately organize details
• Ability to manage multiple tasks with ease and efficiency
• Self-starter with a willingness to try new ideas
• Ability to work independently with minimal supervision and be result oriented
• Positive, can-do attitude coupled with a sense of urgency
• Effective interpersonal skills, including the ability to promote teamwork
• Strong problem-solving skills
• Ability to ensure a high level of customer satisfaction including employees, patients, visitors, faculty, referring physicians and external stakeholders
• Excellent computer operating skills (keyboard, mouse)
• Ability to use various computer applications including EPIC and MS Office
• Basic math skills and knowledge of general accounting principles
• Maintains confidentiality of sensitive information
• Broad knowledge of health care business office practices and principles
• Knowledge of medical and insurance terminology, EOB\xe2\x80\x99s, CPT, ICD coding structures, and billing forms (UB, 1500)
• Knowledge of Business Office policies and procedures
• Knowledge of local, state and federal healthcare regulations

• Follow up with third party payers on outstanding account balances (including credit balances) to facilitate prompt resolution including the following: analyze and reconcile denied payment transactions; compile and file all information needed to assist in appeal of denial; following federal and state regulations to ensure compliance standards are met; monitor timely filing requirements on claims and appeals; follow-up with contracted payers to secure payments on outstanding balances; and evaluate third party payments to ensure accuracy relative to contract language (underpayment/overpayment)

• Evaluate the payment status of outstanding third party claims and resolve any impediments to payment by providing required information such as appropriate medical records, detailed itemization of charges, appropriate claim form, information regarding other insurance benefits, and explanation of charges.

• Review charges to ensure we are filing to correct guarantor (e.g. work comp vs. personal/family) and review and validate appropriate adjustments to accounts in the insurance portfolio based on insurance reimbursement and coverage, contracts, services provided.

• Prepare, review and process all paper and electronic insurance claims timely and accurately, ensuring compliance with claims processing standards.

• Accurately document within billing system all actions taken to reconcile outstanding claim issues and account balance. Additionally, ensure documentation is recorded properly for quality control statistics.

• Resolve claim errors and make recommendations for additions/revisions/deletions to work queues and claim edits to improve efficiency and reduce denials.

• Verify patient coverage information and update registration as required. Develop and maintain knowledge of insurance plans and contractual relationships to ensure correct coverage is attached to the patient and claims are filed appropriately.

• Complete work on special projects, queries and reports as assigned and assist with training of new staff, as needed.

• Conduct written and oral communication with business office teams, payers and others to resolve account problems.

• Attend meetings and training to acquire knowledge and updates with regard to the department/organization, processes, business office policies and reimbursement issues from third party payers.

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