General Summary
Completes assigned revenue cycle tasks. Assists in the completion of submitting electronic and/or manual insurance claims, resolves claim edits, performs insurance account follow-up, researches claim denials for resolution and submits disputes and appeals when necessary. Represents the System in a professional manner while interacting with peers, leaders, patients, and third-party payers to achieve timely payment on accounts in accordance with current government and payer regulations.
Duties and Responsibilities
Essential Functions:
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Conducts timely follow-up on patient accounts billed to insurance companies to determine reasons for delayed or missing payments.
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Investigates denied or rejected claims, reviews insurance remittance advice, and identifies reasons for denial.
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Collaborates with insurance carriers, internal billing teams, and other stakeholders to obtain necessary information and documentation to resolve claims.
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Documents findings and actions taken to resolve denials or delays in payment.
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Initiates and manages appeals or resubmissions of denied claims as appropriate.
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Communicates effectively, verbally and in writing, directly with payors to follow up on outstanding claims, files technical and clinical appeals. Resolves payment delays/non-payments to ensure timely and accurate reimbursement.
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Maintains accurate records of follow-up activities and payment status in the billing system.
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Identifies trends in denied claims and recommends process improvements to reduce denials and expedite payment.
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Provides excellent customer service to patients and internal teams regarding billing inquiries and insurance follow-up.
Common Expectations:
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Maintains appropriate records, reports, and files as required.
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Maintains established policies and procedures, objectives, quality assessment, safety, environmental and infection control standards.
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Participates in educational programs and in-service meetings.
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Provides outstanding service to all customers; fosters teamwork; and practices fiscal responsibility through improvement and innovation.
Required for All Jobs:
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Performs other related duties as identified.
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WellSpan Health has adopted and implemented a compliance program to support WellSpan's values and standards for professionalism, integrity, and ethics. Expected to support and meet the values and standards of the organization and the performance expectations of the job, the department, and the compliance program.
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WellSpan Health has adopted and implemented a privacy program to safeguard the patient information and the business and operational information of the organization. Expected to support and meet the values and standards of the organization to safeguard patient and business/operational information.
The above statements are intended to describe the general nature and level of work being performed. They are not intended to be construed as an exhaustive list of all responsibilities, duties, and skills required of personnel so classified.
Physical Demands:
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Standing - Occasionally
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Walking - Occasionally
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Sitting - Frequently
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Reaching - Rarely
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Talking - Frequently
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Hearing - Frequently
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Repetitive Motions - Occasionally
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Eye/Hand/Foot Coordination - Occasionally
Benefits Offered:
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Comprehensive health benefits
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Retirement savings plan
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Paid time off (PTO)
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Education assistance
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Financial education and support, including DailyPay
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Expanded Paid Parental Leave
For additional details: Benefits & Incentives | WellSpan Careers (joinwellspan.org)
Qualifications
Minimum Education:
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High School Diploma or GED Required
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Associates Degree Preferred
Work Experience:
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1 year Required
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Prior experience in hospital billing, professional billing, or insurance follow-up/denials Preferred
Knowledge, Skills, and Abilities:
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Knowledge of insurance claims processing, payer policies, and medical terminology is essential
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Strong analytical and problem-solving skills to investigate and resolve billing discrepancies
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Excellent verbal and written communication skills for effective interaction with insurance companies and internal teams
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Proficiency with billing software and Microsoft Office Suite (Excel, Word, Outlook)
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Ability to manage multiple accounts and prioritize tasks efficiently in a fast-paced environment
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Attention to detail and commitment to accuracy
