Job Description

JOB SUMMARY:
Proficient in Revenue Cycle Denials Receivable Representative 1. Responsible for handling escalated account and payer issues. Handles complex edits, appeals and account activities such as advanced level tasks, bankruptcies, Risk Management. Acts as a billing and reimbursement expert for a defined payer product line.

EDUCATIONAL REQUIREMENTS
Associate's degree preferred.

CERTIFICATION & LICENSURE REQUIREMENTS
None specified

EXPERIENCE REQUIREMENTS
One year customer service experience in health care required or a high performer as an Accounts Receivable Representative 1. Credit and collection experience preferred. Proficient computer knowledge related to Microsoft Office applications such as Word, Excel, Outlook and Receivables Management systems.

SKILLS AND KNOWLEDGE
Possesses the "other knowledge and skills" of the Revenue Cycle Accounts Receivable Representative 1. Knowledge of basic medical coding and third-party operating procedures and practices with proficiency in EncoderPro.

ESSENTIAL FUNCTIONS:

• Must be able to perform essential job functions of Revenue Cycle Accounts Receivable Representative 1.
• Handles complex edits, correspondence and advanced level workqueues such as but not limited to retro review, EOB balancing, credit adjustment review and processing of Illinois Workers’ Compensation Commission (IWCC).
• Handles escalated account activities such as but not limited to healthcare liens, settlement requests, workers’ compensation reimbursement computation forms and attorney requests.
• Handles escalated appeals.
• Assists with training and education to staff for accuracy.
• Identifies payer and system issues to initiate project requests for process improvements.
• Assists in credit balance review according to organization’s credit balance/refund policy.
• Attends and participates in meetings with payer specific provider representatives to maximize reimbursement and minimize denials through problem solving, collaboration and consensus.

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