+ Performs pre-billing and billing functions to insure successful outcome of claim submission and payment. + Follows all billing and regulatory guidelines, per insurance carrier, to insure facility compliance. + Collaborates with all Team Members within SPH to insure an accurate and timely billing. + Collect outstanding insurance company balances as quickly as possible by applying collection best practices as defined by Leadership + Utilize various A/R reports to target aged balances for collection to meet and maintain performance goals. + Evaluate partial payments to determine if further reimbursement is valid + Compose technical denial arguments for reconsideration, including both written and telephonically + Overcome objections that prevent payment of the claim and gain commitment for payment through concise and effective appeal argument + Escalate exhausted appeal efforts to Leadership + Submits retro authorization to insurance within insurance carrier guidelines + Researches and takes necessary action to follow up on unpaid claims using ATB’s and/or assigned work lists + Works pending claims in the CMS Direct Data Entry software (DDE) and SPH claims Clearinghouse + Analyses insurance payments received to verify account was paid per contract, if not, contacts insurance to reprocess + Use effective documentation standards that support a strong historical record of actions taken on the account + Reviews and follows through on credit balances through take back initiation, refund initiation, and/or payment re-application. + Reports Medicare credits quarterly to Medicare on appropriate form and supplies all supporting documentation + Logs and adjusts all appropriate Medicare bad debt cancels so they can be reported on year-end financial reports. + Works patient and insurance correspondence timely. Respond and document in account and scan documents into patient account for future reference. + Response to all queries timely to insure Gold Standard Customer Service + Role requires adherence to quality assurance guidelines as well as established productivity standards to support the work unit’s performance expectations