"Account Assistant 4 - Coding Refund Team"

Overview

Under the direction and supervision of the Associate Director and Team Lead/Manager, employee will be responsible for insurance follow-up on carrier denials with a focus on refund requests for Yale Medicine. Employee will also function as a liaison in the day to day follow-up of denied and no response claims to obtain maximum reimbursement for services rendered by Yale Medicine and other related practices

Follow up of denied and appealed claims for Yale Medicine and its related specialties and practices. Follow up of coding denials and refund requests according to the rejection code posted in Epic and follow process guidelines established by the Central Business Office management team. Process and review carrier denials for adherence to specific payer Explanation of Benefits. Knowledge of appealing denials in order to receive maximum reimbursement for Yale Medicine. Write, send and follow up on appeals as appropriate by contacting the carrier, researching carrier policies, review of medical documentation and/or work collaboratively with YM staff to ensure maximum reimbursement. Directly communicate with third party insurance carriers, patients, and other listed payers in order to investigate payment/reimbursement delays for billed charges, for both primary and secondary claims. Respond to requests from insurance carriers, Yale Medicine clinical departments and/or patients for supporting documentation necessary in order to obtain maximum reimbursement. Work closely with other centralized and non centralized units within the Business Office to resolve outstanding claim/billing/payer issues or requests. Identify and report carrier/specialty issues that will assist in claim processing and resolution. Responsible for documentation and follow up of claims worked through payment, rejection or appeal. Strong knowledge of insurance carrier and specialty related issues. Review and validate charge review and claim edits as assigned to ensure correct coding and in compliance with Yale Medicine guidelines. Ability to review and understand medical records and coding. Interact with all Yale Medicine departments as required to resolve matters relevant to coding, fees, medical documentation and other problems to expedite the processing of claims, payments and rejections. Special projects as assigned by Yale Medicine staff and management and all other job related duties.

Required Skills and Abilities

• Excellent interpersonal skills. Ability to deal with people in a tactful and courteous manner.
• Excellent communication skills, both oral and written.
• Ability to work independently, organize and prioritize work assigned in order to meet goals and deadlines.
• Strong ability to process high volume workload accurately and professionally.
• Demonstrated record of excellent attendance and punctuality. Proper demeanor and attire.

Preferred Skills and Abilities

• Current CPC Certification
• Knowledge and working experience with CPT, ICD10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edit’s (MUE’s).
• Working knowledge and experience with Microsoft Office especially Excel and Word
• Working experience of EPIC and EPIC work queues
• PC data entry experience
• Ability to work independently and part of a team
• Ability to multi-task in a high volume environment

Principal Responsibilities

1. Serves as a principal source of information on rules and procedures governing University accounts receivable. Oversees and instructs support staff. 2. Oversees maintenance of account files, ensuring accuracy and completeness. Reviews payment histories. 3. Resolves problem and delinquent accounts with supervisor and collection agency. Assists with final review and disposition of problem accounts. 4. Recommends and implements changes to systems and operating procedures. Composes form letters and correspondence used in accounts receivable activities. 5. Researches individual accounts. Summarizes findings in reports. Completes and processes forms. Performs clerical functions incidental to account activity.

Required Education and Experience

Four years of related work experience, two of them in the same job family at the next lower level, and high school level education; or two years of related work experience and an Associate's degree, or an equivalent combination of experience and education.