Full time position - normal business hours, Monday - Friday
Responsible for clerical support of the Patient Accounts Government Unit. Works with unit representatives (PAR), outside facilities/sites, clinical departments, and HIM to obtain medical documentation/records and medical necessity letters. Researches and completes BCBS correspondence letters and returned mail related to claims. Documents refund requests and takes appropriate system adjustments. Maintains all logs appropriate to the Government Unit.
Primary Duties and Responsibilities
1. Research and complete all BCBS correspondence letters including but not limited to: No Dependent Coverage, COB, Alpha Prefix, EOB, Authorization, Student Status, and Cancellation letters.
2. Obtains medical records for additional information claim denials including all appropriate records for BCBS correspondence letters using established DMG guidelines for order and return of medical records. Follows up timely on receipt of records. Files reconsideration of claim appeal with appropriate documentation in accordance with HIPAA guidelines.
3. Follows up monthly on unit health plan appeals, forwards unpaid appeals to appropriate unit member. Maintains health plan appeal log.
4. Documents all refund requests for Government Health Plan in Epic. Forwards requests to appropriate Government Staff to research and respond to request. Enter refund adjustments as directed by Government Staff, Team Lead, and Supervisor. Forwards paperwork to payment post for processing and maintains refund log.
5. Adjusts approved payer-non-payable adjustment codes.
6. Demonstrates an understanding of coverage and registration guidelines as they apply to Government payers and product type.
7. Researches insurance company mail returns, researched claim office address and updates coverage accordingly. Verifies insurance claim office address using established sources and protocols. May utilize Internet as part of this process. Re-files claims with carrier/claim office as directed by health plan.
8. Understands filing order based on Coordination of Benefits (COB) guidelines.
9. Interacts with other group, administration and Patient Accounts Department staff to successfully reduce the A/R.
10. Maintains department’s policies and procedure timeliness and accuracy standards.
11. Performs other projects and duties as related to organization’s objectives.
12. Maintains confidentiality of all information as stipulated in the HIPAA Privacy Rules and DMG confidentiality policy.
General Skills and Abilities Required
1. Effective in communicating verbally with other staff and departments.
2. Schedules and prioritizes for self.
3. Fosters teamwork and positive rapport within all departments to maximize achievement of goals.
Special Skills or Licensure Requirements
1. Knowledge of Word and Excel
2. Knowledge of ICD-9, CPT and HCPCS.
3. No licensure requirements.
Education and/or Training Required
High school graduate or one to two years related training. Data entry skills of 40 WPM required.
One to two years of related experience.
Typical Working Conditions
The work environment characteristics described here are representative of those an employee encounters while performing the essential function of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Typical Physical Demands
- Working with and around other people.
- High level of computer work.
- The noise level in the work environment is usually moderate.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Position in general is sedentary. Person must be able to move throughout and between facilities. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to stand and walk. The employee must occasionally lift and/or move up to 10 pounds.
Dupage Medical Group - 3 years ago