-Reviews and initiates the initial appeal for underpayments observing all timely requirements to secure reimbursement due to Hoag.
-Reviews and completes payor and/or patient correspondence in a timely manner.
-Escalates to the payor and/or patient accounts that need to be appealed due to improper billing, coding and/or underpayments.
-Reports new/unknown billing edits to direct supervisor for review and resolution.
-Has a strong understanding of the Revenue Cycle processes, from Patient Access (authorizations admissions) through Patient Financial Services (billing & collections), including procedures and policies.
-Has thorough knowledge of managed care contracts, current payor rates, understanding of terms and conditions, as well as Federal and State requirements.
-Interprets Explanation of Benefits (EOBs) and Electronic Admitt ance Advices (ERAs) to ensure proper payment as well asassist and educate patients and colleagues with understanding of benefit plans.
-Understanding of hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.
Required Skills & Experience:
-One year of previous hospital business experience, or equivalent required or strong background in customer service.
-Basic experience with insurance plans, hospital reimbursement methodology, and/or ICD10 and CPT coding.