Prepares and forwards patient claims to appropriate third-party payers. Analyzes and reviews claims to ensure that payer-specific billing requirements are met. Follows up on billing, determines and applies appropriate adjustments, answers inquiries and updates accounts as necessary.
May perform research and analysis.
Participate in departmental/division performance improvement and quality assurance controls.
May perform account audits and develop and execute corrective actions plans.
Participate in LEAN Collaboratives and partner with the clinic team to research and solve systemic problems.
May have specialized areas of responsibility (e.g. government & non-government billing, appeal processing, review & approval of refunds in addition to coding corrections, etc.).
May manage specialized work queues independently due to knowledge and unique system security clearance.
Identify system and technology needs.
Participate in advancing use of technology. Ensures systems meet all regulatory and compliance requirements. Perform tasks which require higher level of security access.
May lead in testing, install updates and act as the liaison with the vendor to make appropriate programming changes and solve systems issues.
Perform duties in support of team members daily operations, problem solving, projects, and communications with payor representatives.
Supplement training beyond training on services, systems and payor specifics.
Perform specialty services functions and may direct daily activities for specific work functions.
Act as a resource within the department/division.
Provide instruction for performing non-routine functions.
High school diploma or equivalent
3 to 5 years related experience
Bachelor's degree or equivalent work experience
Using time efficiently and productively; prioritizing multiple tasks properly to meet deadlines; recognizing time constraints and adjusting work schedule to address them.
???Knowledge of Field - Intrm
Knowledge of regulations, procedures and best practices in field
???Systems - Basic
Working knowledge of systems relevant to the field
Meticulously keeping track of details without becoming overwhelmed by them; being exacting, precise, and accurate; spotting minor imperfections or errors and taking action to correct them
Demonstrates an independent work initiative, sound judgment, diplomacy, tact and professional demeanor
Ability to independently work through details of a problem to reach a positive solution
Excellent verbal, written and/or interpersonal communication skills
Training and/or experience in databases and Microsoft applications
At Cincinnati Children’s, we come to work with one goal: to make children’s health better. We believe in a team approach, both in caring for patients and their families, and in advancing science and discovery. We strive to do better, and find energy and inspiration in our shared purpose. If you want to be the best you can be, you can do it at Cincinnati Children’s.