Job Focus: 

This position is responsible for Customer Service phone calls, legal release of information, initial billing, re-billing, and account follow-up and/or grievance preparation of assigned Client EMR Accounts Receivable. The responsibilities may include account maintenance of specialized or multiple payers including state and federal government programs, managed care, commercial and other insurance groups. Partners with other team members and health plans to facilitate the appropriate and prompt payment of claims. This individual must demonstrate a commitment to the organization’s strategic plans, short and long-term goals and mission, vision, and values by representing the company in a caring and professional manner.

Primary/Essential Expectations For Success:

· Accepts and resolves incoming patient billing inquiries 

· Responsible for Legal Billing release of information documentation 

· Initial biller and follow up of workman’s compensation, IBCCP and liability claims 

· Reviews and/or scrubs final billed initial claims for accuracy and completeness prior to submitting to payer

· Submits electronic and/or hardcopy claims with any attachments as per the contract timely filing criteria

· Documents all account activity in the hospital/client system and The Q with clear and concise notes

· Within appropriate time frames, contact the health plan by phone or website to determine status of claim

· Documents all follow-up actions in the hospital/professional account notes and sets up account for additional review based on client expectations for follow-up of unresolved accounts

· Research and validate the paid or partially paid claim status is in accordance with the expectations outlined in the client contract agreement

· Deliberately and thoroughly reviews any denied, dis-allowed, or non-covered claims / charges and determines accuracy based on contract language 

· Resolves any technical issues when warranted with payer 

· Follows client specific procedures to request adjustments and refunds 

· Prepares appeal and necessary documentation for authorization, coding, level of care and/or length of stay denials

· Follow guidelines for prioritization and timely filing deadlines

Physical/Mental Demands, Environment: 

• Prolonged periods of sitting at a desk and working on a computer 
• Must be able to lift 15 pounds at one time 
• Must be able to structure your home office to ensure patient information is secure meeting the regulatory  expectations  

Skills Needed to Be Successful: 

· Maintains compliance with regulations and laws applicable to job

· Professional level of communication with video, phone, and email 

· Ability to effectively prioritize the work to meet deadlines and expectations

· Meets the quality and productivity measures as outlined by Quadris

· Brings positive energy to work

· Uses critical thinking skills

· Being present and focused on assigned tasks and eliminates distractions

· Being a self-starter

· Ability to work independently and within a team atmosphere

Core Talent Essentials:

· High School diploma or equivalent

· 2+ years previous experience in healthcare revenue cycle management

· Ability to work independently and within a team atmosphere

· Self-motivated and passionate about our mission and values of quality work

· Proficient application of business/office standard processes and technical applications