Overview
This role involves managing the revenue cycle follow-up process for both Professional Billing (PB/CMS-1500) and Hospital Billing (HB/UB-04) claims. The primary responsibility is to ensure timely and accurate follow-up on accounts receivable, resolve unpaid and underpaid claims, and facilitate reimbursement from government and commercial payers. Strong knowledge of 837P/837I transaction sets, EOB/ERA reconciliation, and payer-specific follow-up requirements is essential.
Responsibilities
Claim Follow-Up – PB & HB
- Monitor and follow up on outstanding PB (CMS-1500 / 837P) and HB (UB-04 / 837I) claims through phone calls, payer websites, and Epic work queues to ensure timely reimbursement.
- Investigate and resolve unpaid, underpaid, and rejected claims by collaborating with insurance providers and internal departments.
- Analyze account history and previous actions in Epic before determining next steps to resolve claims.
- Identify payer trends and payment discrepancies across PB and HB claim types and escalate findings to leadership.
- Determine when claim corrections, rebilling (837P or 837I), and resubmissions are necessary.
- Escalate claims with payers for resolution of inaccurate or delayed processing.
Appeals & Reconsiderations
- Submit reconsiderations and appeals for PB and HB claims with appropriate attachments, documentation, and clinical justification.
- Comply with payer-specific appeal deadlines and formatting requirements for Medicare, Medicaid, and commercial payers.
Payer & System Knowledge
- Navigate Epic to manage HB and PB work queues, document follow-up activities, and review 835 remittance/ERA data.
- Use payer portals such as Availity, NaviMedix, Arkansas DHS portal, and others to verify claim status and obtain EOBs.
- Utilize client-provided resources to ensure accuracy and resolve claims according to expectations.
Compliance & Documentation
- Maintain accurate and detailed documentation of all follow-up activities in Epic.
- Communicate effectively with insurance companies, patients, and internal teams to resolve claims and support cash collections.
- Ensure compliance with federal, state, and payer regulations, as well as hospital and physician practice policies.
- Maintain confidentiality of patient and account information in accordance with HIPAA.
- Adhere to policies and procedures outlined in the Employee Handbook and Code of Conduct.
- Participate actively in the Corporate Compliance Program.
- Maintain a confidential and orderly remote work environment.
- Meet goals and objectives assigned by management.
- Assist with additional projects as assigned.
Expected Results
- Achieve high levels of client and patient satisfaction (CSAT).
- Meet quality scores per defined process standards.
- Deliver process-specific metrics such as AR days, cash collected, and productivity units.
- Maintain adherence to regulatory compliance requirements.
- Ensure schedule adherence.
Requirements
Educational Qualifications
- High school diploma or equivalent required.
- Associate’s or Bachelor’s degree in Health Information Management, Business, or related field preferred.
Work Experience
- Minimum of 2 years experience in healthcare revenue cycle, claims processing, or accounts receivable follow-up.
- Demonstrated experience with PB (CMS-1500 / 837P) and/or HB (UB-04 / 837I) claim follow-up.
- Prior experience with Epic billing and/or follow-up work queues strongly preferred.
- Familiarity with Medicaid, Medicare, and commercial payers preferred.
- Experience interpreting 835 ERA / EOB remittance data.
Competencies & Skills
- Strong knowledge of PB and HB billing workflows, claim lifecycle, and payer follow-up processes.
- Proficiency with Epic modules related to HB and/or PB, including work queues, claim correction, and rebilling.
- Familiarity with CARC/RARC denial and adjustment reason codes.
- Ability to interpret EOB, ERA (835), and remittance advice for PB and HB claims.
- Knowledge of payer portals such as Availity, Arkansas DHS, and commercial payer sites.
- Effective communication skills with payers, patients, colleagues, and management in both in-person and virtual settings.
- Professional and courteous demeanor.
- Self-motivated with ability to work productively with minimal supervision.
- Proactive and creative problem-solving skills.
- Strong time management and organizational skills to prioritize multiple tasks.
- Proficient in PC operations with typing speed of 30–40 words per minute.
Compensation & Benefits
- Medical, Vision, Dental insurance
- 401(k) retirement plan
- Paid Time Off
Equal Opportunity
All qualified applicants will be considered for employment without regard to race, color, age, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by federal, state, or local law.