Medical Billing & Follow-Up Specialist

Overview

National Jewish Health is seeking an experienced Medical Billing & Follow-Up Specialist to support the resolution of unpaid and denied insurance claims. This role contacts insurance carriers to verify claim status, resolve payment delays, and ensure accurate reimbursement. The ideal candidate has prior experience in a medical setting and a solid understanding of insurance billing, claim follow-up, and payer-specific requirements.

• Contacts insurance companies daily via phone and payer portals to follow up on unpaid or denied claims and resolve reimbursement issues.
• Requests, submits, and reviews missing or corrected claim and patient information to support timely payment.
• Reviews CPT and ICD-10 codes to ensure claims meet payer requirements and drafts and submits appeals when necessary.
• Investigates payment delays and incorrect payments while maintaining detailed documentation of all actions in the patient accounting system.
• Communicates effectively with patients, providers, and insurance representatives and demonstrates strong attention to detail, computer proficiency, and written and verbal communication skills.

Responsible for financial resolution of receivables by verifying appropriate reimbursement for services rendered. Achieves this by persuasive collection techniques, problem solving, complex mathematical proficiency, resolving eligibility, insurance claims billing, insurance claim follow up and/or other related obstacles, according to the existing procedures for collection and by utilizing all available patient accounting and/or payor software.

• Has a thorough understanding of CPT, HCPCS & ICD-10 codes, HCFA and UB04 claim forms, DRG, and insurance benefits including authorizations/referrals.
• Works daily with automated worklists and payor systems to perform account audits of insurance and patient payments; utilizes claims editing software and/or payor software to review claims history to address and resolve payment delays and/or incorrect payments.
• Maintains ability to read and comprehend all payors’ claims adjudication vouchers, explanation of benefits (EOB), or electronic remittance advice (ERA); uses vouchers, EOBs, and ERAs to confirm proper processing of claims and reimbursement levels.
• Maintains current knowledge of regulatory and procedural requirements related to the assigned workload, including contracted payor documents, contract matrix, and state and federal regulations.
• Contacts insurance companies or clients and uses negotiation techniques to elicit payment or account resolution. When necessary, collaborates with billers to perform re-bills or secondary billing and follows up on collections according to procedures to meet productivity and receivable goals.
• Performs appeals of insurance denials and/or incorrect reimbursement; facilitates medical record documentation submissions when medical necessity is the basis for denial.
• Processes refunds, payment transfers and adjustments for the account workload according to Patient Financial Services (PFS) policies.
• Contacts patients when necessary to elicit claims and account resolution; demonstrates good customer service and knowledge when contacting patients.
• Identifies self-pay accounts and potential bad debt accounts for referral to outside agencies or attorneys for further collection efforts.

• Communicates regularly with PFS Supervisor or Manager regarding high-risk accounts.
• Responds timely to account inquiry calls from patients or insurance companies and researches claims or questions with the responsible department; provides customers with requested financial information or refers them to other resources at National Jewish Health.
• Provides PFS Supervisor with weekly productivity statistics and reports workload fluctuations in a timely manner. Maintains individual goals established by PFS management.
• Participates in team and departmental meetings and shares ideas for improved work processes; acts as a back-up to staff absences as necessary.
• Accountability:
  Accepts responsibility for self and as a team member; demonstrates honesty, problem solving, and commitment to organizational success and to National Jewish Health.
• Adaptability:
  Maintains effectiveness during changes in responsibilities or environment and adapts to new structures, processes, requirements, or cultures.
• Attention to Detail:
  Attends to all aspects of tasks, sets high standards, and ensures accuracy and quality of work.
• Collaboration/Teamwork:
  Works with others to achieve shared goals and treats colleagues with dignity and respect.
• Decision Making:
  Analyzes issues and uses data to determine appropriate actions and solutions.
• Drive for Results:
  Maintains high goals and measures progress to meet or exceed targets.
• Managing Work and Time:
  Manages time and resources efficiently and adheres to project timelines and priorities.

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• Be available to work as scheduled and…