• Submits all clean claims to the appropriate insurance payer the same day the claim is loaded into the Editor with the exception of weekends and Holidays 
• Reviews payer EOB?s but not limited to payment accuracy, patient liability, updating the financial class, notify commercial biller to submit secondary or tertiary insurance, and appeal grievance.
• Files appeals on denied claims and/or forwards to the Nurse Auditor for review/appeal
• Enter denials on the Denial Log
• Enter the USPS tracking number in the Patient Accounts system
• Enter the USPS delivered date in the Patient Accounts system
• Contact payer to ensure an appeal was received
• Maintain better than an 80% clean claim average.
• Attach but not limited to the medical records, implant invoice, and itemized bill to the claim before billing if applicable
• Process incoming mail correspondence from the payers within 3 business days
• Work assigned billing reports within 2 business days
• Work the rejection report daily to resolve problem accounts
• Follow up with the payer via phone and/or the website for the status of outstanding claims
• Respond to patient inquiries within 2 business days
• Respond to interdepartmental inquiries within 2 business days
• Respond to payer requests within 2 business days
• Respond to emails within 2 business days
• Submit newborn notifications if applicable
• Review/resolve the accounts on the Unbilled Report daily (accounts that are on hold and haven?t been processed by the editor).
• Enter detailed notes explaining account activity in the Patient Accounts system
• Process payments over the phone if applicable
• Print UB and 1500 hardcopy claims when required by the payer
• Submit primary, secondary and tertiary claims before the timely filing deadline
• Research late charges to determine the cause; inform supervisor of regular occurrences and trends

• Report A/R account trending issues to the Supervisor and the Director of Patient Financial Services
• Follow up with all insurance companies within 30 days of billing if there is no payment on the account
• Work the eScan reports timely if applicable
• Forward patient complaints regarding care to the supervisor for entry into the appropriate resolution pathway
• Notify supervisor of payers that accept electronic billing currently billed hard copy

Education

Preferred:

    High School

Licenses & Certifications

Preferred:

    C-Heartsaver

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About CHRISTUS Health

CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.

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