Job Description

Inspire health. Serve with compassion. Be the difference.

Job Summary

Provides accurate and timely submission of claims for Prisma Health to various payer sources based on filing guidelines. Follows-up on specialty accounts in a timely manner with increased focus on aged and high dollar accounts. Researches payer variances after comparing expected to actual reimbursement received. Partners with other departments when issues arise such as missing payments, payer delays, and technical denials. Ensures payment amounts from insurance carriers are correct and posted to the right accounts. Reviews accounts after payment posting to determine if balance needs moved to secondary payer or patient liability.

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.
• Expedites billing functions, including but not limited to resolving errors that prevent the account from billing (e.g. discharged not final billed/stop bill) and the resolution of claim edits in order to submit to claims clearinghouse for electronic submission. Processes the daily paper claims submissions for primary and secondary claims.
• Follows up on specialty accounts receivable (AR) accounts assigned to determine if the claim has been accepted and processed for payment or denied. Reviews claim rejections and re-bills accounts when appropriate. Effectively and timely identifies the root cause of non-payment denials and works with the insurance company, the patient, and Prisma Health departments to find resolution to claim denials, making all necessary claim and account corrections to ensure the full reimbursement of services rendered.
• Escalates accounts both at the payer and/or internally when appropriate in accordance with the Prisma Health escalation guidelines to keep AR aging at acceptable levels for payer issues.
• Identifies system issues through trending and repetitive actions that require workflow review or changes to resolve compliant billing.
• Utilizes proper tools to communicate with Prisma Health department teams on specific errors for corrections related to their area of responsibility.
• Contacts insurance payers, patients, or guarantors at established intervals to follow-up on status of delinquent accounts, determines the reason of delay and expedites payment.
• Meets daily performance productivity and quality goals. Identifies areas for improvements. Monitors quality levels, finds root cause of quality problems and owns/acts on quality problems. Contributes to department goals. Effectively utilizes time and resources, assisting co-workers as time allows.
• Knowledge of payers and provides support to other team members as needed. Demonstrates exceptional relationships with external payers and internal departments in accordance with Prisma Health Standards of Behavior and Compliance.
• Performs other duties as assigned.

Supervisory/Management Responsibilities

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma/highest degree earned
• Experience - Three (3) years in hospital claims and billing follow-up

In Lieu Of

• Bachelor's degree and 2 years of hospital billing, follow-up/denials. ​

Required Certifications, Registrations, Licenses

• CRCA preferred
• CRCR preferred

Knowledge, Skills, and Abilities

• Understanding of the hospital and physician claim forms
• Knowledge of payer guidelines. ​
• Maintains professional growth and development through seminars, workshops, in-service meetings, current literature and professional affiliations to keep abreast of latest trends in field of expertise.
• Understands, promotes and adheres to all matters of compliance with laws and regulations.
• Understands the Standards of Behaviors.
• Communication skills preferred
• Attention to details preferred.

Work Shift

Day (United States of America)

Location

Colonial Life Building

Facility

Corporate

Department

Patient Financial Services

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.