Account Assistant 4

Overview

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

Follow up of denied and no insurance response for Yale Medicine and its related specialties and practices. Oversees maintenance of account files ensuring accuracy and completeness.  Review payment history.  Review, work and resolve problem and delinquent accounts with supervisor and collection agency.  Recommend and implement changes to system and operation procedures.  Compose form letters and correspondence used in account receivable activities.  Researches individual accounts.  Follow up of denials 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. 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 claim edits. Strong knowledge of insurance carrier and specialty related issues. Review and validate charge review and claim edits as assigned to ensure correct coding, billing guidelines and in compliance with Yale Medicine guidelines. Special projects as assigned by Yale Medicine staff and management and all other job related duties.

Required Skills and Abilities

1. Knowledge and working experience with CPT, ICD10, HCPC, modifiers, National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edit’s (MUE’s).
2. Knowledge and experience with Microsoft Office especially Excel and Word.
3. Experience of EPIC and EPIC work queues. PC data entry experience.
4. Ability to work independently and part of a team. Ability to multi-task in a high volume environment.
5. Strong verbal and written communication skills. Excellent attendance and reliability. Must be highly energetic and motivated with the ability to work under pressure and handle and maintain a high volume of accounts.

Preferred Skills and Abilities

Current CPC or CPB certification

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.