General Descriptionfull-time position with Physicians Billing Service; 40 hours per week; Monday - Friday
Serve as an information resource on payor medical policies, reimbursement policies and billing requirements, maintaining a thorough knowledge of various insurance policies and billing requirements. Resolve or assist in the resolution of claim processing or payment disputes.
On a daily basis, provide professional consultation and assistance regarding industry standards, regulations, and payment operations, to department staff, Production Unit Managers, Associate Directors, Directors, and Senior Directors within the SOM and JHBP to improve receivable collectability and staff efficiencies.
Proactively research, interpret, and communicate complex Third Party Payer guidelines and specifications that impact accurate claims submission, payments ,and appeals that affect PBS operations and the filing and reimbursement of claims for numerous Production Billing Unit Specialties.
Initiate and hold meetings, onsite sessions, and conference calls with Third Party Payers, Production Unit Managers and staff for issue resolution and education.
Assist in enhancing communication throughout PBS, as well as, creating training guides and job-aides to educate billing staff utilizing payer websites, surveying payers' contacts and other resources.
Develop and maintain liaisons with Third Party Payer representatives through face to face meetings, telephone interactions and written correspondence to enhance contractual compliance, payment accuracy and understanding of carrier system workflows and policies.
Participate in the resolution of escalated claims, third party payer issues and payment disputes. Makes referrals to appropriate resources as needed.
Assist Unit Manager in compiling and analyzing spreadsheets for special projects.
Generate and analyze variance reports on specific payors, departments, physicians and/or procedures as back up to the third party department.
Utilize internal and external resources including IDX, EPIC, electronic medical records, payer websites, and other resources to facilitate efficient operations, issue resolution, and education.
Assist in the training of staff.
Perform other duties as required.