AR Rep Denial Biller

North Shore-Long Island Jewish Health System

Performs a variety of duties related to billing and collection.  Reviews the accuracy of payments to identify denial/underpayment trends. Submits technical appeals to carriers

1. Reviews the accuracy of payments to identify denial/underpayment trends:

• Confirms account balance reflects accurate reimbursement rate.

• Confirms plan code on account represents correct plan code of the carrier to reimbursement claim. Recode if appropriate, order rebill, refers to Credit Collection to repost.

• Identifies claims with potential systemic issues.

• Reviews payment and denials in conjunction with Contract Management and the carrier’s contract to determine if claim was adjudicated correctly.

• Initiates follow up calls and/or spreadsheets to carrier to confirm claims will be reprocessed according to contract.

• Requests documentation needed by carrier via the TRAC system, Medical Records Quic, DRG charges coding request.

• Initiates technical appeals to carriers to overturn denial received.

• Writes appeals, follow-up on appeals and has ability to retrieve letters.

2. Maintains and reconciles records.

3. Performs related duties, as required

High School Diploma or equivalent, required. 

• Minimum one (1) year billing experience, required.

• Knowledge of Medicare, Medicaid and third party insurance billing procedures; CPT, ICD9/10, and DRG coding, required.

• Ability to input data into computerized billing system, required.

• Ability to communicate effectively.

• Proficiency in Microsoft Office; Excel, Outlook and Word, required.

• Proficiency in general office duties; phone skills, fax, copy machines, adding machine.