Cerner Commercial Follow Up

📋 Description

• • As a Cerner Commercial Follow Up Specialist at TruBridge, you will play a critical role in ensuring the financial health of our client hospitals by meticulously managing and resolving outstanding inpatient claims. This position is central to our revenue cycle operations, focusing specifically on UB-04 claims submitted to commercial payers.
• • Your primary responsibility will be to conduct in-depth follow-up on all unpaid, underpaid, denied, or rejected inpatient hospital claims. This involves a proactive and persistent approach to identifying issues, researching root causes, and implementing effective solutions to secure accurate and timely reimbursement.
• • You will act as a vital liaison, bridging communication between our hospital and clinic partners, various insurance payers, and our internal revenue cycle teams. This requires excellent interpersonal and communication skills to navigate complex payer relationships and internal workflows.
• • A key aspect of the role involves the detailed analysis of Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs). You will need to interpret these documents accurately to understand payer decisions, identify discrepancies, and determine the most appropriate course of action for each claim.
• • You will be responsible for the accurate posting of denials to patient accounts, utilizing specific denial reason codes and appropriate CAS (Commonly Accepted Standard) codes to ensure proper tracking and reporting of claim rejections.
• • This role demands a proactive approach to claim correction and appeals. You will be tasked with filing necessary claim corrections and submitting well-documented appeals to insurance carriers, advocating for our clients to achieve maximum reimbursement.
• • Identifying and rectifying billing errors is a crucial function. You will need to collaborate with relevant internal teams to coordinate corrections before claims are resubmitted, preventing future rejections and delays.
• • Meticulous documentation is paramount. You will be expected to thoroughly document all follow-up actions, payer communications, and account activities within our system, maintaining a clear and comprehensive audit trail.
• • Effective communication with insurance representatives will be essential. This includes verifying claim status, requesting reconsiderations for denied claims, and escalating unresolved issues to ensure timely resolution.
• • You will be expected to consistently meet daily productivity and quality assurance standards, contributing to the overall efficiency and effectiveness of the revenue cycle team.
• • Beyond routine claim follow-up, you may be assigned to assist with backlog projects. This could involve resolving credit balances, researching unapplied payments, and performing account reconciliations to ensure financial accuracy.
• • You will serve as a valuable resource for your team members, sharing your expertise on payer policies, emerging denial trends, and effective follow-up strategies.
• • Active participation in team projects and continuous process improvement initiatives is encouraged, as we strive to optimize our revenue cycle management processes.
• • Maintaining the confidentiality and integrity of patient health information is non-negotiable. You must strictly adhere to HIPAA regulations and all other relevant privacy and security standards.
• • Staying current with evolving payer guidelines, reimbursement policies, and regulatory changes within the healthcare industry is vital to performing your role effectively and ensuring compliance.
• • This role offers the opportunity to significantly impact our clients' financial performance by reducing accounts receivable days and maximizing revenue capture through diligent claim management.