Allegheny Health Network Careers

Date Posted: 10-31-2016

Position Number: D-CLAIMS

Location: Four Allegheny Center

Allegheny Health Network is an integrated delivery network focused on preserving health care choice and providing affordable, high-quality care to the people in our communities.  With more than 14,000 employees including 7,400 health care professionals, nearly 200 primary care and specialty care practices, Allegheny Health Network includes seven hospitals in Pennsylvania with nearly 2,400 licensed beds.

Allegheny Health Network’s clinical expertise ranges from primary care to the most complex surgical procedures.  Services include cancer diagnosis and treatment, cardiovascular care, neurological and neurosurgical services, organ transplantation, orthopedic and rehabilitation services, and women’s health.

Department: Revenue Cycle

Status: Full-Time

Job Summary: Provides extensive support covering all aspects of billing related claims edits (pre A/R) in an effort to submit clean claims to the third party insurers. Works collaboratively with other departments within the Allegheny Health Network to obtain required information to complete the claim prior to submission.

Job Responsibilities:

• Ensures timely, accurate and efficient processing of claims edits via EPIC work queues.
• Meets daily claims edit resolutions goals by reviewing, analyzing, and obtaining appropriate documentation based on payer requirements and regulations.
• Prepares electronic and paper claims and sends with appropriate attachments.
• Conducts research and provides updates and current status of claims edit work queues using the appropriate data management system (EPIC).
• Resolves issues that are adversely impacting claims submission in a timely and accurate manner.
• Completes or requests adjustments to accounts based on dollar threshold.
• Communicates information and ideas to make system-wide process improvements.
• Updates patient accounts regarding changes and modifications in plan benefits and other contract information relevant to the claims follow up and collection process.
• Documents claim processing activity on patient accounts.
• Serves as a communication link to various departments and external payers by developing positive relationships with managed care organizations and outside agencies, and clinical areas within the
• Performs liaison services to both internal and external customers providing assistance in claims
• Assists with education of internal staff and external customers to bring about the timely, accurate, and cost effective adjudication of all claims.
• Works collaboratively with other departments to facilitate the insurance collections process and to improve overall cash collection.
• Monitors the status of claims in work queues and conducts routine, periodic follow up on previously researched claims items.
• Monitors, reviews, and suggests revisions or updates to existing forms, documents, and processes required to submit a clean claim.
• Assists other departments/functional areas as needed with billing, claims, or claims follow up related tasks.
• Ensures completeness of claims by following national, local, and internal billing requirements promoting prompt and accurate submission and payment.
• Maintains awareness of current regulations.
• Initiates practices that support current regulations.
• Shares knowledge of current regulations with staff. Analyzes current practices and makes recommendations for process improvements.

Requirements:

• Must have knowledge of insurance billing regulations and reimbursement procedures; excellent phone etiquette and customer service skills; and an analytical aptitude and ability to translate functional needs to a computerized environment.
• Two years of previous patient financial services experience in a healthcare environment.
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Preferred:

• Associate's Degree preferred
• Familiarity with medical terminology, ICD-9 and CPT-4 coding; third party payer’s in a healthcare billing environment; and Epic billing module preferred.
• Previous experience with computerized billing and/or healthcare billing preferred.