Company :Allegheny Health NetworkJob Description : 

GENERAL OVERVIEW:

This job is responsible for providing support, covering all aspects of insurance billing, claims follow up and collections, including direct contact to the appropriate third-party payers for all unpaid claims including denied claims and those requiring appeal.

ESSENTIAL RESPONSIBILITIES:

Ensures efficient processing of billing claims, insurance follow up, collection activities and denials. Assists in meeting cash collection goals by reviewing, completing, and submitting appropriate documentation based on payer requirements. Conducts research and provides updates and current status of collection efforts using the appropriate data management system (EPIC/Meditech).Performs billing, follow-up and collection functions for third parties, resolving issues that impact or delay claims payment. Communicates information and ideas to make system-wide process improvements. Updates data regarding changes and modifications in plan benefits and other contract information relevant to the billing or claims follow up and collection process.Serves as support staff for various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the organization. Reviews and responds to correspondence and inquiries generated by third party payers. Provides medical record copies and other pertinent information to the appropriate sources throughout the billing and collection process. Works collaboratively to facilitate the insurance billing and collections process to improve overall cash collection.Supports overall Revenue Cycle processes to achieve established targets and goals, including the completion of special/specific assigned projects or tasks.Monitors the status of denials, appeals, and claim errors by using folders/work queues and conducting routine, periodic follow up on previously researched claims items. Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to facilitate timely billing and collections.Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment. Maintains awareness of current regulations. Initiates practices that support current regulations.Performs other duties as assigned or required

QUALIFICATIONS:

Minimum

Health care experience of up to 3 years

Preferred

Associate's Degree/completion of college level coursework

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times.  In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. 

Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, age, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, age, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability. 

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