Job Description

Primary Location:

250 E Liberty St

Address:

250 East Liberty St.
Louisville, KY 40202

Shift:

First Shift (United States of America)UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.
With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

This position requires thorough knowledge of the Uniform Bill, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicare eligibility, benefits, determining primary payer, and covered benefits.

Essential Functions:

• Monitors and resolves claims holding on discharged not final billed (DNFB) list
• Ensures claims are filed electronically except for specified paper claims
• Identifies payers being submitted on paper rather than electronically and communicate the opportunities to leadership
• Follow ups on unpaid Medicare and Medicare Advantage claims in a timely manner
• Ensures high-dollar accounts have consistent follow up until the account has been resolved
• Responsible for reviewing and understanding explanation of benefits/remittance advice
• Ensures statements are generated for the patient responsibility amounts
• Utilizes insurance websites to view and resolve claims
• Performs extensive account follow-up and provide analysis of problem accounts
• Documents all follow up efforts in a clear and concise manner into the AR system
• Submits shadow claims to Medicare for inpatient Medicare Advantage payers
• Audits and researches accounts, payment postings and contractuals to confirm the accuracy of the balance of the account
• Adheres to Medicare Secondary Payer Questionnaire guidelines for coordination of payment/coverage with all other appropriate payers
• Ensures medical record requests are documented and submitted in a timely manner
• Makes phone contact with patient, physician office, attorney, etc. for additional information to process claims, as needed

Other Functions:

• Identifies and reports all trends that may provide insight into payment challenges
• Maintains familiarity with inpatient-only procedure list and works with Revenue Cycle leadership to prevent denials
• Works on assigned accounts as directed while reaching daily productivity goals
• Completes tasks by deadline
• Attends seminars as requested
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
• Maintain compliance with all company policies, procedures and standards of conduct
• Performs other duties as assigned

Additional Job Description:

Education:

• High School Diploma or GED/Equivalent (required)

Experience:

• One (1) year of patient registration, billing or equivalent experience (required)
• Working knowledge of medical and insurance terms (preferred)

Job Competency:

Knowledge, Skills, and Abilities critical to this role:

• Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies
• Knowledge of general insurance requirements
• Experience working directly with EOBs and contractual adjustments
• Ability to communicate verbally/in writing with professionalism
• Ability to meet productivity expectations

Language Ability:

• Must be able to communicate effectively in both verbal and written formats

Reasoning Ability

• Ability to break down problems or tasks; using prior knowledge and experience to identify causes and consequences of events

Computer Skills:

• General computer knowledge
• Must have the ability to learn and use relevant systems appropriately

Additional Responsibilities:

• Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
• Maintains confidentiality and protects sensitive data at all times
• Adheres to organizational and department specific safety standards and guidelines
• Works collaboratively and supports efforts of team members
• Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community