Overview
Conduct reviews of denied claims and audits of registration/insurance verification activities to improve denial rates and enhance revenue. Provide in-service training on insurance identification, verification, and reporting. When directed, perform audit duties under the guidance of the Compliance Program.
Responsibilities
- Establish and maintain positive relationships with patients, visitors, and staff. Interact professionally and courteously, maintaining a positive public perception of Bronxcare Health System.
- Participate in Performance/Quality Improvement activities, including data collection, analysis, risk management, claims processing, and CQI team support, adhering to safety, security, infection control, and customer service policies.
- Collaborate with Clinic Administration to increase revenue by reducing payment denials and system bill holds. Keep the Bill Hold Tracker updated (Pre & Post Billing).
- Develop corrective action plans with Clinic Operations to improve insurance identification and reporting processes.
- Coordinate with Patient Financial Services (PFS) and Information Services to enhance communication, tracking, and reporting of denials, holds, and activities.
- Maintain a Clinic Insurance Eligibility Hotline for questions regarding financial eligibility.
- Work with clinics and PFS to ensure timely, complete, and accurate billing through improved communication and feedback.
- Inform clinics of policy, system, and operational changes related to insurance, eligibility, and reporting, including updates on Managed Care Payers and Medicare.
- Maintain and reconcile daily therapy services.
- Assist clinics with account updates and information reporting.
- Perform in-service training on insurance identification and reporting; conduct coaching and performance reviews across clinic locations.
- Ensure provider credentialing information is consistent across systems and report discrepancies to management.
- Identify operational issues, report to management, and recommend corrective actions to help drive revenue.
- Identify and report specific reason codes for 277 responses daily to billing managers.
- Monitor productivity and edits weekly to identify spikes; implement workflow changes to improve efficiency.
- Prepare registration reconciliation reports with various departments.
- Review miscellaneous insurance reports daily to identify claims requiring correction.
- Review daily interface rejection reports promptly.
- Scan authorizations and correspondence into the DMS system.
Qualifications
- At least five (5) years of hospital or healthcare patient accounts experience.
- High School diploma or GED; Bachelor's degree preferred.
- Basic computer skills.
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