Billing Follow Up Representative II

Responsible for daily claims submissions, including electronic transmittals, computer-based processing, and hard copy claims, to the appropriate responsible parties.

Acts as a resource for the team, assists with more complex issues, supports problem resolution, and may provide training.

May participate in quality audits, productivity initiatives, and special projects.

Uses multiple systems to resolve outstanding claims in accordance with compliance guidelines.

Performs pre-billing, billing, and follow-up activities on open insurance claims using revenue cycle knowledge, including CPT, ICD-10, HCPCS, NDC, revenue codes, and medical terminology.

Obtains necessary documentation from various sources.

Communicates timely and accurately with internal teams and external customers, including third-party payors, auditors, and other entities, by phone or mail.

Serves as a liaison with external third-party payer representatives to validate and correct information and to ensure regulatory and contractual compliance.

Reviews incoming insurance correspondence and responds appropriately.

Identifies coding, compliance, contracting, claim form edits/errors, and credentialing trends and brings them to leadership’s attention when they may affect reimbursement delays or denials.

Stays current on insurance payer updates, single case agreements, and assists management with recommendations for implementing edits and alerts.

Enters and updates patient and insurance information in the patient accounting system.

Appeals claims to help ensure contracted amounts are received from third-party payors.

Maintains assigned payer KPIs within department and insurance guideline standards.

Compiles information for referral of accounts to internal and external partners as needed.

Maintains clear and accurate online documentation of all billing and collection activity for each account.

Follows Advocate Aurora Health policies and departmental collections policies and procedures.

Demonstrates proficiency in the software systems used by AAH.

Refers unusual, unreasonable, or inaccurate account information to a supervisor for approval or final disposition, including write-offs outside corporate policy or issues beyond normal scope.