• Provides billing support to Patient Financial Services. • Performs payment posting to support revenue cycle operations. • Identifies denials for follow up and performs account follow up activities. • Updates information on accounts and organizes work in a timely manner. • Participates in department meetings and provides feedback to management.

• Performs retrospective coding review of denied charges for physician services. • Reviews medical records for completeness and accuracy to ensure documentation supports the services billed and all documentation standards are met for billing. • Make corrections to charges when necessary. • Analyze for invalid denial trends, payer specific carrier submission requirements & system optimization. • Performs extensive follow-up to investigate and resolve payment denial trends. • Resolves outstanding accounts utilizing ancillary applications and websites as tools to retrieve medical documentation. • Researches and interprets payer contract terms and compiles necessary supporting documentation templates for appeals. • Ensures denial reviews are conducted in a timely manner. • Maintains up-to-date policies and procedures and knowledge related to managed care and third party payors. • Participates in annual and on-going mandatory compliance training. • Fulfills Continuing Education Units necessary to maintain certification status. • Assists in training current and new employees on the use of systems and departmental policies and procedures. • Performs other related duties as assigned.

• Coordinates, completes, and monitors the provider/facility payer credentialing process • Processes credentialing and re-credentialing applications for health care providers • Sends, reviews, and verifies credentialing applications • Loads and maintains provider information in an online credentialing database system • Tracks license and certification expirations for medical staff to ensure timely renewals • Handles and resolves inquiries regarding credentialing information, process, or status

• Submits monthly claims and invoices along with discharge claims within two business days of creation. • Reviews Payor Aging and works accounts accordingly for multiple sites within a Central Business Office Environment. • Ensures accurate, complete, and timely account follow-up. Documents accounts within Perimeter guidelines. • Resolves claim processing issues in a timely manner, escalates problem claims to their supervisor. • Resolves credit balances in a timely manner. • Reviews Remittance Advices daily and prioritizes Zero Pay accounts for immediate resolution. • Works directly with Payor Plans/Funding Sources to resolve ongoing issues. • Communicates Payor updates to Revenue Cycle Leadership in a timely manner. • Reviews Facility Correspondence in a timely manner. • Reviews new Admissions for Payor Plan accuracy. • Prepares write-off requests based on review of balances, and submits to leadership for review and approval • Reviews Denial Log and coordinates Denial write-offs with Facility UM Director. • Familiar with billing requirements for payor plans...not limited to Medicaid and Medicare.