Transplant Billing Coordinator (Remote)

Responsibilities:

• Processes claims in billing claim queues as assigned using established procedures. Strive to work all claims in the assigned queue by week end. Corrects held claims in claim queues using established procedures. Fully utilize all available information in EPIC and Claim Agent in order to ensure billing is complete, accurate and timely. Promptly assigns to the appropriate Department’s WQ in EPIC to request assistance from an external department to resolve a billing deficiency. The request should be clear, concise and written with excellent grammar. Communicates billing claim queue issues &/or account queue issues to the Billing Management Team, includes but not limited to charge and coding errors. Works assigned Billing Work list &/or EPIC WQ’s. Strive to achieve zero WIP by week end. Initiates and/or completes any insurance updates in EPIC required to accurately submit claims to the appropriate carrier. Accurately identifies split medical vs. transplant claims, ensuring payer & effective dates are appropriately updated in EPIC. Ensures transplant inpatient claims reflect the expected reimbursement from the payer. In addition will adjust balances for any claim identified as under the global phases and is included in the reimbursement for the transplant. Addresses and/or resolve any issues identified by the payer that impacts the processing of a clean claim. Prepares and present transplant claim information as requested for but not limited to internal escalations and/or payer escalation meetings. Coordinates with PB (Professional Billing) representative on any claims, under the payer contract, that are required to be billed along with the HB (Hospital Billing) claims (included in billing packets).Communicates directly with the Transplant Teams at the facilities regarding registration and/or any issue that may impact the processing of a claim to the payer and obtaining the expected reimbursement in a timely manner. Adheres to the Quality Review and Billing Productivity standards established for each unit or individual, recognizing that approved special projects will be calculated into the Productivity standards. Continually looks for ways to improve the quality and/or efficiency of policies and procedures that affect the Revenue Cycle. Helps and supports fellow employees in their work to contribute to overall organizational success. Proactively shares information and trends Exhibits an openness to change without complaint. Demonstrates knowledge of the Compliance Program, including UPHS Standards of Conduct, compliance policies and procedures. Maintains good working relationship with other employees, contact departments and payers

Education or Equivalent Experience:

• H.S. Diploma/GED AND 4+ years of related experience required
• Experience handling billing and account receivables in healthcare set-up or related field (preferred)
• Medical billing experience with a strong knowledge of Medicare, Medicaid, Blue Cross and Commerical Insurances (preferred)
• AAHAM- Certified Revenue Cycle Specialist (preferred)