Professional Billing Denials and Follow Up Representative

Important Update:
At Northwestern Medicine safety is always a top priority. In response to the COVID-19 pandemic, Northwestern Medicine has moved to a more virtual recruitment process including telephone and video interviews to help ensure the health and safety of our employees, candidates, and communities. Also, some hiring activities may be delayed or suspended in certain geographic areas and job categories.

• Job Title:
  
  Professional Billing Denials and Follow Up Representative
• Location:
  
  Warrenville, Illinois, United States
• Business Unit:
  Northwestern Medicine Corporate
• Job Function:
  Patient Accounting Support
• Shift: Day (1st)
• Employment Type:
  
  Full-Time
• Job Requisition
• Salary Range: $20.03 – $26.04 hourly (placement depends on experience and internal equity)

• $10,000 Tuition Reimbursement per year ($5,700 part‑time)
• $10,000 Student Loan Repayment ($5,000 part‑time)
• $1,000 Professional Development per year ($500 part‑time)
• $250 Wellbeing Fund per year ($125 for part‑time)
• Matching 401(k)
• Excellent medical, dental, and vision coverage
• Life insurance
• Annual Employee Salary Increase and Incentive Bonus
• Paid time off and Holiday pay

The Professional Billing Denials and Follow Up Representative reflects the mission, vision, and values of Northwestern Medicine, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines, and regulatory standards.

• Consistently meet the current productivity and quality standards in timely resolution of all claim edits, reporting of candidates for billing, outbound compliant claim submission, clinical documentation requirements, and any other communication required regarding claims to ensure timely filing of claims 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 with root cause analysis to reduce/prevent future denials while working to overturn denials for payment resolution.
• Compliant follow‑up correspondence to third‑party payers regarding outstanding accounts receivables (e.g., statements, letters, e‑mails, faxes, portal mail).
• Support operations related to optimum third‑party accounts receivables (Managed Care, Commercial, Medicare, Medicaid, Replacement plans, Workers Compensation, Corporate Accounts, Research, and Specialty AR Accounts).
• Perform daily, systematic reviews of work lists to ensure all accounts already to be worked are completed.
• Utilize Government, Commercial, and regulatory guidelines for collection of outstanding accounts. Recommend accounts for contractual or administrative write‑off with appropriate justifications and documentation.
• Practice HIPAA privacy standards and ensure compliance with patient health information privacy practices.
• Identify opportunities for customer, system, and process improvement and submit to management.
• Follow the NMHC general Policy and Procedures, the Departmental Policy and Procedures, and any Emergency Preparedness Procedures. Follow Joint Commission and outside regulatory agencies mandated rules and procedures.
• Utilize assigned menus and pathways in the hospital mainframe system and report software application problems to the appropriate supervisor.
• Utilize assigned menus and pathways in external software applications and report software application problems to the appropriate supervisor.
• Utilize assigned computer hardware and report hardware problems to the appropriate supervisor.
• Participate in the 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…