Physician Billing Denial Anlayst

Position: Physician Billing Denial Anlayst-1
* Works collaboratively with payors, patients, internal contacts, and third party follow up vendors to identify and rectify denial issues resulting in timely reimbursement and final disposition of claims.
* Verifies accuracy of payment for correct reimbursement and resolves issues related to over/underpayments. Performs necessary error corrections and/or initiates a refund request to rectify the account over payment. Documents all activities/actions taken on an individual patient account within the billing system.
* Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payor communications, federal registrars and contractual guidelines to ensure compliance. Maintains familiarity with government and commercial payor policies via web sites and portals and can research and interpret them effectively.
* Participates in scheduled payor meetings by preparing and documenting open issues log (update balances, open A/R, discussion notes) and dispute spreadsheets
* Prepare, submit, track, and maintain resolution of level II and III appeals
* Works with our internal and external customers to maintain data integrity within patient accounting systems.
* Works closely with Customer Service, Patient Relations, Risk Management, and Compliance to provide follow up and direction with complicated account inquiries.
* Performs complex guarantor account reviews on all financial classes related to outstanding insurance claim balance.
* Actively participates in analysis of work processes; documents and provides feedback to assist in enhancing overall patient satisfaction and work process improvements.
* Participates actively in department meetings, providing updates to AR Teams and leadership. Assumes additional responsibilities and special projects as assigned.
* Collaborate with other departments to ensure smooth work processes (Consolidated Services, Accounts Payable, Finance, etc.).
* Act as an Epic Super User and Application/Task Tester for Physician Billing projects
* Performs job functions adhering to service principles with customer service focus of innovation, service excellence and teamwork to provide the highest quality care and service to our patients, families, co-workers, and others.
* Performs other job-related tasks as assigned.
* High school graduate required. Associates, BS or BA degree preferred.
* Five to seven years of physician or hospital billing experience and/or training. Minimum of three years of business office experience in physician office setting with significant time spent in communication with patients/families and third-party payers.
* CPC certification highly preferred. Extensive knowledge of ICD-10, CPT coding, medical terminology, third party billing and collections, required.
* Ability to perform financial analysis and create reports using Microsoft Office products.
* Strong leadership, planning, and organizational skills with strong analytical ability.
* Strong project management skills with keen attention to details.
* Previous Epic experience desired.
* Excellent communication and listening skills required.
* Ability to handle multiple priorities is required.
* Must be able to track, respond, trend, and multitask within the practice management system.
* Knowledge of windows-based personal computers is required and experience with electronic claims editing software preferred.
* Thorough knowledge of patient accounting, third party payer procedures, governmental regulations and managed care contracting to be effectively proactive in the billing and collection process, and to respond to inquiries on patient accounts in a customer satisfaction manner.

At Lurie Children’s, we are committed to competitive and fair compensation aligned with market rates and internal equity, reflecting individual contributions, experience, and expertise. The pay range for this job indicates minimum and maximum targets for the position. Ranges are regularly reviewed to stay aligned with market conditions. In addition to base salary, Lurie Children’s offer a comprehensive rewards package that may include differentials for some hourly employees, leadership incentives for select roles, health and retirement benefits, and wellbeing programs.

For more details on other compensation, consult your recruiter or click the following  to learn more about our benefits.
* Supplemental Life, AD&D and Disability
* Critical Illness, Accident and Hospital Indemnity coverage
* Tuition assistance
* Student loan servicing and support
* Adoption benefits
* Backup Childcare and Eldercare
* Employee Assistance Program, and other specialized behavioral health services and resources for employees and family members
* Discount on services at Lurie Children’s facilities
* Discount purchasing program

Ann & Robert H. Lurie Children’s Hospital of Chicago provides superior pediatric care in a setting that offers the latest benefits and innovations in medical technology, research and family-friendly design.
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