UofL Health

Compensation

Full Description

Primary Location: 250 E Liberty St Address: 250 East Liberty St. Louisville, KY 40202 Shift: First Shift (United States of America) Job Description Summary: Job Description: This position requires thorough knowledge of the Uniform Bill, Medicaid, Medicare and Medicare Advantage billing, secondary deductible/coinsurance billing, and the Direct Data Entry (DDE) system for follow up. The specialist performs all duties related to timely and efficient billing and follow-up using their thorough understanding of Medicaid eligibility, benefits, determining primary payer, and covered benefits. Additional Job Description: Essential Functions Monitor and resolve claims holding on discharged not final billed (DNFB) list. Assure all claims are filed electronically except for some paper claims. Process claims identified from insurance discovery. Submit account for appeal on accounts where retroactive coverage has been obtained. Identify payers being submitted on paper rather than electronically and communicate the opportunities to leadership. Follow up on unpaid Medicaid and Managed Medicaid claims in a timely manner. High dollar accounts will have consistent follow up until the account has been resolved. Responsible for reviewing and understanding explanation of benefits/remittance advice. Assure statements are generated for the patient responsibility amounts. Utilize insurance websites to view and resolve claims. Perform extensive account follow-up and provide analysis of problem accounts. Document all follow up efforts in a clear and concise manner into the AR system. Compliance with State and Federal Regulations. Audit, research accounts, payment posting, contractuals to confirm the accuracy of the balance of the account. Assure medical record requests are documented and submitted in a timely manner. Collaborate with denials team on difficult or reoccurring denials. Complete tasks by deadline. Identify and report all trends that may provide insight into payment challenges. Phone contact with patient, physician office, attorney, etc. for additional information to process the claim. Work assigned accounts as directed while reaching daily productivity goals. Attend seminars as requested. Other duties as assigned. Skills, Knowledge or Abilities critical to this role: Working knowledge of medical and insurance terms. Ability to review, comprehend, discuss HCFA billing with Insurance or Government agencies. Knowledge of general insurance requirements. Experience working directly with EOBs and contractual adjustments. UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers, Brown Cancer Center, Eye Institute, nearly 200 physician practice locations and more than 1,000 providers in Louisville and the surrounding counties, including southern Indiana. Additional access to UofL Health is provided through a partnership with Carroll County Memorial Hospital. With more than 14,000 team members – physicians, surgeons, nurses, pharmacists and other highly-skilled health care professionals, UofL Health is focused on one mission: to transform the health of communities we serve through compassionate, innovative, patient-centered care. Please login into Workday and search for Job Hub.