Professional Billing Denials and Follow Up Representative

Professional Billing Denials and Follow Up Representative

The Professional Billing Denials and Follow Up Representative at Northwestern Medicine Central DuPage Hospital is responsible for ensuring accurate, timely billing and follow‑up on all claims, and for optimizing accounts receivable processes across all payer types.

Bachelor’s acceptance of salary range: $20.03 - $26.04 (Hourly Rate). Placement within this range depends on relevant work experience, internal equity, and labor‑union guidelines when applicable.

We provide a comprehensive benefits program that supports employees’ physical, emotional, and financial well‑being. For details, visit our Benefits page.

As a member of the Patient Accounting team, the Representative works in accordance with NM’s Code of Ethics and Corporate Compliance Program, meeting all regulatory and accreditation standards.

• Consistently meet current productivity and quality standards in timely resolution of all claim edits, reporting of candidates for bill, outbound compliant claim submission, clinical documentation requirements, and any other communication required (verbal or written) regarding claims ensuring timely filing and clean, complete, and accurate claims.
• Consistently meet or exceed productivity standards, targets, error ratios, and reporting requirements assigned by the Patient Accounting Lead Financial Assessor and Operations Coordinator.
• Timely follow‑up and collection of third‑party payer receivables, including denials and appeals follow‑up, root‑cause analysis to reduce/prevent future denials, and efforts to overturn denials for payment resolution.
• Compliant follow‑up correspondence to third‑party payers regarding outstanding accounts receivables (Statements, letters, e‑mails, faxes, portal mail, etc.).
• Support operations related to optimum third‑party accounts receivables across Managed Care, Commercial, Medicare, Medicaid, Replacement plans, Workers Compensation, Corporate, Research, and Specialty AR Accounts.
• Perform daily systematic reviews of work lists to ensure all accounts to be worked are completed.
• Utilize Government, Commercial, and regulatory guidelines for collection of outstanding accounts, recommend accounts for contractual or administrative write‑off and provide appropriate justification and documentation.
• Practice HIPAA privacy standards and ensure compliance with patient health information practices, contributing to team effort to achieve departmental accounts receivable goals.
• Identify opportunities for customer, system, and process improvement and submit them to management.
• Follow NMHC general policy and procedures, Departmental policy and procedures, and any Emergency Preparedness procedures, as well as Joint Commission and outside regulatory agencies mandated rules.
• Utilize assigned menus and pathways in the hospital mainframe system and external software applications, reporting software and hardware problems to the appropriate supervisor.
• Participate in testing for assigned software applications, including verification of field integrity.
• Assist the Patient Accounting Operational Coordinator and Patient Accounting Team Lead Financial Assessor with special projects and other duties as assigned.
• Attend training and seminars as assigned and approved by the Patient Accounting Operations Coordinator.

• Demonstrate excellent customer service through oral and written communication, providing assistance and expertise to patients, guarantors, and internal and external contacts.
• Demonstrate proficient use of systems and execution of processes in all areas of responsibilities.
• Maintain working knowledge of physician and facility billing and follow‑up, including insurance rules and regulations, especially Medicare and Medicaid; knowledge of HIPAA standards.
• Perform mathematical calculations.
• Communicate effectively with patients, families, public, co‑workers, and professional offices; possess basic knowledge of medical terminology and billing practices.

• High School diploma.
• One year related work experience or college degree.
• Ability to perform mathematical calculations.
• Basic…