Insurance Reimbursement Auditor, Patient Accounting, UofL Health-University of Louisville Hospital, Days, Full Time

UofL Health
 Louisville, KY

Overview

Primarily responsible for the review and follow up on paid insurance claims (including $0.00 pay) and payor recoupments to successfully determine if reimbursement is accurate according to current contracted rates and follow up with payers on outstanding monies due for services rendered to a patient. This position will provide “root cause” analysis and reporting of revenue opportunities to ensure appropriate reimbursement.

Responsibilities

  • Perform thorough research of paid claims (including $0.00 pay) for appropriate follow up with payer.
  • Provide detailed analysis of findings and payer trends.
  • Review claim remittances to determine reimbursement rates and methodologies used by the payer when processing the claim.
  • Identify opportunities with underpayment or contract language that is determinant to reimbursement and report findings to leadership.
  • Perform extensive review of high dollar accounts that are subject to alternative reimbursement terms to validate payments are in accordance with contracted rates.
  • Responsible for reviewing and understanding explanation of benefits/remittance advice from third-party payers.
  • Process and review incoming correspondence from payers related to underpayment or high dollar/outlier payment discrepancies.
  • Audit, research accounts, payment posting, and contractuals to confirm the accuracy of the balance, financial class, and follow up schedule on the account.
  • Phone contact with patient, physician office, attorney, etc. for additional information to provide payer in order to process claim in accordance with contracted rates.
  • Communicate payment discrepancies to payer specific provider representatives via email, phone, or scheduled in-person meetings.
  • Work with reimbursement and contract modeling team members to verify contracted rates are properly calculated with contract modeling system.
  • Maintain regular contact with Managed Care & Contracting management team to ensure all new contract agreements/updated rates are received timely and effective dates for new rates are communicated to the appropriate Revenue Cycle teams.
  • Prepare and submit letters, emails, faxes, online inquiries, appeals, and adjustments.
  • Document all follow up efforts in a clear and concise manner into the AR system.
  • Work assigned accounts as directed while reaching daily productivity goals.
  • Complete tasks by deadline provided by leadership.
  • Participate in system testing and training.
  • Attend seminars as requested.
  • Other duties as assigned.

Qualifications

Minimum Education and Experience

  • High School Diploma or GED
  • 2-3 years of billing, insurance follow-up or insurance payor experience
  • Experience performing account resolution with third-party payors is preferred
  • Experience in working with ICD-10, revenue codes, CPT-4 and HCPCS
  • Moderate computer proficiency including working knowledge of MS Excel, Word and Outlook

Knowledge, Skills, and Abilities

  • Ability to read and interpret documents, i.e. contracts, claims, instructions, policies and procedures in written (in English) form.
  • Ability to calculate rates using mathematical skills.
  • Ability to define problems, collect data, and establish facts to execute sound financial decisions in regard to patient account(s).
  • Must have detailed knowledge of the uniform bill guidelines.
  • Ability to be persistent in the follow up of underpaid or partially paid claims in a timely manner.
  • Ability to review, comprehend, and discuss HCFA billing with Insurance or Government agencies.
  • Knowledge of general insurance requirements.
  • Experience working directly with EOBs, contractual adjustments, and payer contracts.
  • General computer knowledge and working with electronic filing systems.
  • Ability to communicate verbally and in writing with professionalism.
  • Organizational and documentation skills to ensure timely follow-up and accurate record keeping.
  • Ability to meet productivity expectations.
  • Strong team player.
  • Strong self-motivation to achieve goals.
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