Position Summary:
We have an exciting opportunity to join our team as a Billing Representative III.
Under general direction submits claims. Follows up on unpaid balances (insurance or patient), corrects errors, enters claim information, submits authorization/precertification requests with insurance companies, follows up on denied claims and/or authorizations, and submits appeals as necessary.
Job Responsibilities:
- Cross-cover other areas in the office as assigned by management including Accounts Receivable/Denials, Customer Service, or Authorizations.
- Perform billing tasks assigned by management which may include data entry, claim review, charge review, accounts receivable follow-up, or other related responsibilities.
- Provide input on system edits, processes, policies, and billing procedures to ensure maximization of revenues.
- Perform daily tasks in assigned work queues and according to manager assignments.
- Identify payer, provider credentialing, and/or coding issues and address them with management.
- Follow workflows provided in training classes and request additional training as needed.
- Utilize CBO Pathways as a guide for determining actions needed to resolve unpaid or incorrectly paid claims and/or for authorizing procedures in assigned work queue(s) using payer websites, billing system information, and training within the expected timeframe.
- Review reports to identify revenue opportunities and unpaid claims.
- Adhere to general practices and FGP guidelines on compliance issues and patient confidentiality.
- Communicate with providers, patients, coders, or other responsible persons to ensure that claims are correctly processed by third-party payers.
- Work following operational policies and procedures, and regulatory requirements.
- Participate in workgroups and meetings. Attend all required training classes. Escalate issues to management as needed. Maintain confidentiality. Read and apply policies and procedures to make appropriate decisions. Coordinate functions and work cooperatively with others. Explain processes and procedures to others; perform other related duties as assigned.
- Responsible for assisting the professional billing staff within the CBO with difficult and escalated issues.
- Assist department supervisor on special projects and staff training.
- Appeal complex denials through a review of payer policies, coding, contracts, and medical records. Utilize subject matter experts as needed.
- Make appropriate corrections to the system to satisfy/edit payer requirements and re-submit claims as needed.
Patient Experience & Access:
- Serves as NYU Langone Health Faculty Group Practice Brand Ambassador by upholding the NYULH Mission, vision, and values and promoting excellence in the patient experience, during every encounter.
- Drives consistency in every patient and colleague encounter by embodying the core principles of our FGP Service Strategy CARES (Connect, Align, Respond, Ensure, and Sign).
- Greets patients warmly and professionally, stating name and role, and communicates each step of the care/interaction as appropriate.
- Works collaboratively with colleagues and site management to ensure a positive experience and timely resolution for all patient interactions and inquiries whether in person, by phone, or via electronic messaging.
- Proactively anticipates patient needs, and participates in service recovery by applying the LEARN model (Listen, Empathize, Apologize, Resolve, Notify), and escalates to leadership as appropriate.
- Shares ideas or any observed areas of opportunity, to improve patient experience and patient access, with appropriate leadership.
- Partners with Patient Access Center and Central Billing Office team members to support collaboration and promote a positive patient experience.
- Takes a proactive approach in ensuring that practice staff are fully versed in the Access Agreement gold standard principles.
Minimum Qualifications:
To qualify you must have a High School Diploma or GED.
Experience in medical billing, accounts receivable, insurance, or related duties; Knowledge of CPT and ICD10; medical billing software; English usage, grammar, and spelling; basic math; 3 years experience in a similar role.
Light, accurate keyboarding skills are required. Candidates must receive a score of 35 words per minute (wpm) or greater on the typing assessment that will be administered before onboarding.
Qualified candidates must effectively communicate with all levels of the organization.
NYU Langone Florida is an equal opportunity and affirmative action employer committed to diversity and inclusion in all aspects of recruiting and employment. All qualified individuals are encouraged to apply and will receive consideration without regard to race, color, gender, gender identity or expression, sex, sexual orientation, transgender status, gender dysphoria, national origin, age, religion, disability, military and veteran status, marital or parental status, citizenship status, genetic information or any other factor which cannot lawfully be used as a basis for an employment decision. We require applications to be completed online.
If you wish to view NYU Langone Florida's EEO policies, please click here. Please click here to view the Federal "EEO is the law" poster or visit https://www.dol.gov/ofccp/regs/compliance/posters/ofccpost.htm for more information.
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