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