Billing And Follow Up Representative

Our client is looking for a BILLING & FOLLOW UP REP on a remote basis for their location in Farmington Hills, MI.

Temporary up to 6 months

Client requires proof of vaccination

Michigan Residents Only.

SUMMARY:

The Billing & Follow-Up Representative reviews, researches, and processes claims in accordance with contracts and policies to determine the extent of liability and entitlement, as well as to adjudicate claims as appropriate. The core responsibilities will include: coding and processing claim forms; reviewing claims for complete information, correcting and completing forms as needed; accessing information and translating data into information acceptable to the claims processing system; and preparing claims for return to provider/subscriber if additional information in needed. Additional follow-up responsibilities include: maintaining all appropriate claims files and following up on suspended claims; assisting, identifying, researching and resolving coordination of benefits, subrogation, and general inquiry issues, then communicating the results; and preparing formal history reviews.

ESSENTIAL DUTIES & RESPONSIBILITIES:

Knows, understands, incorporates, and demonstrates the Mission, Vision, and Values in behaviors, practices, and decisions.

Submits 3rd party and patient claims (electronically or by hard copy), including the maintenance of bill holds and the correction of errors in an effort to provide timely, accurate billing services. Edits UB-92 (and where appropriate HCFA-1500) claim forms within the patient accounting system, using proper data element instructions for each payer, applying principles of coordination of benefits, and ensuring that correct ICD-9 diagnosis, HCPCS and CPT procedure codes are utilized. Ensures that claims are in accordance with regulations set forth by the state and federal governments, 3rd party payers, and guidelines.

Performs all billing and follow-up functions, including the investigation of over-payments, underpayments, payment delays resulting from denied, rejected and/or pending claims, with the objective of appropriately maximizing reimbursement based upon services delivered and ensuring that the claim is paid/settled in the most timely manner. These functions will be in coordination with the Central Operations team, depending on threshold metrics defined by work queues for the Shared Service Centers and Central Operations.

Utilizes available data and resources to make decisions regarding complexity of claim processing and payment propensity, and the appropriateness of transferring account to the Disputed Claims Management team, Collection vendor(s) or other resources for follow-up:

If you are a high performer and would like to work for an equally high performing company and you think the above opportunity is appropriate for you, we invite you to apply to this job and email your resume to [email protected].

We treat all resumes with strict confidentiality. We will always contact you first before submitting your resume to our client(s) for review. If you do not receive correspondence, you are not a fit for this position.

At Harvard Resource Solutions, our talent acquisition team is proud to provide our clients with the most qualified Administrative & Clerical talent in the industry today.