Job Description

• The Billing & Follow-Up Representative reviews, research, and processes claims in accordance for the resubmission of primary, secondary, and tertiary claims per respective regulations and policies.

• The Billing & Follow-Up Representative communicates with third-party, representatives as necessary to complete claims processing and /or resolve problem claims. Process claims daily and correct front-end edits timely for submissions.

• Billing and Follow – Up Representative must Follow-up daily on post processing activity including but not limited to, rejected billings, adjustments, and rebilling, and denied claims for accounts that are greater than 30 days old.
• Billing & Follow – Up core responsibility will include coding and processing claim encounters, reviewing claims for complete information, accessing information and translating data into information acceptable to the claims system.

• Reprocess rejections, and file appeals for claim denials to ensure maximum reimbursement.

• Serves as a process specialist for front end and back end professional billing revenue cycle staffs ensuring the goal of shortening the revenue cycle.
• Monitors performance and communicates issues to the management staff.
• Works minimum standard number of accounts per payer per day.
• Decision Making: Independent judgment in making decisions involving non-routine problems under general supervision.
• Meets or exceeds collection goals by payer each month.
• Maintains confidentiality adheres to all HIPAA guidelines/regulations.
• Other duties as assigned from time to time.

• Meets regularly with Manager to review status of work queues, A/R, special projects, and problematic or unusual accounts.
• Responds to questions, requests, and support calls, efficiently and professionally, within established timeframes.
• Attends staff meetings and continuing education in-service training as directed by Manager.