Insurance Rep

This position is responsible for supporting Radiology Revenue Cycle Operations (RRCO). The Radiology Account Resolution Insurance Representative reports to the Radiology Billing Supervisor and is primarily responsible for successful resolution of accounts. This position will work out of assigned PB and HB work queues handling claim edits, follow up work queue denials transferred from the Professional Billing Office that require department intervention and Account work queue denials that require review for retro authorizations. Individuals are responsible for investigating claim denials and underpayments by insurance carriers and appeal for payment or make appropriate adjustment. Exercising good judgement in escalating identified denial trends or root cause of denials to mitigate future denials, expedite the reprocessing of claims and maximize opportunities to enhance front end claim edits to facilitate a first pass resolution. This position is also responsible for creating self-pay estimates and responding to insurance inquiries from the Radiology Financial Clearance teams.

· Responsible for patient account research in relation to working accounts within the assigned PB and HB follow-up and account work queues.

· Maintain the highest level of billing standards in keeping with Medicare, Medicaid, and

· other insurance guidelines.

· Identify untimely accounts and perform accurate and timely write offs adhering to department and health system guidelines.

· Answering revenue cycle inquiries from patients, schedulers, front desk teams and pre-service teams.

· Work directly with the leadership team to achieve strategic and operational objectives of the department.

· Meet or exceed established performance targets (productivity and quality) established by the Radiology Billing Supervisor.

· Support department leadership in maintaining a high level of data integrity.

· Perform duties in accordance with Penn Medicine values, policies, and procedures.

· Carry out other duties as assigned to support the unit, department, entity and health system organization.

Education: 

H.S Diploma or GED required and 3+ years of Medical Office experience. 

Medical Billing and Coding experience preferred