Hospital (UB04) Follow-up Biller - Cerner

📋 Description

• • Join TruBridge as a dedicated Hospital (UB04) Follow-up Biller, a critical remote role focused on ensuring optimal reimbursement for outstanding inpatient hospital claims.
• • In this vital position, you will act as a key liaison, bridging communication between hospitals, clinics, insurance payers, and our internal revenue cycle teams. Your expertise will directly impact the financial health of our client facilities.
• • You will be responsible for meticulously managing and resolving a diverse range of outstanding inpatient hospital claims, with a specific emphasis on the UB-04 form.
• • Your primary objective will be to conduct detailed and proactive follow-up on all unpaid, underpaid, denied, or rejected claims, ensuring that every claim receives the attention it deserves.
• • This involves a deep dive into claim details, identifying the root cause of payment issues, and implementing effective strategies for resolution.
• • You will research and resolve complex denied, rejected, zero-paid, or underpaid claims, requiring a keen analytical approach to understand payer logic and identify discrepancies.
• • A significant part of your role will involve analyzing Explanation of Benefits (EOBs) and Electronic Remittance Advices (ERAs) to accurately determine the appropriate next steps for each claim.
• • You will be adept at posting denials to patient accounts, utilizing precise denial reason codes and appropriate CAS (Commonly Accepted Standards) codes to ensure accurate record-keeping and trend analysis.
• • Filing claim corrections and submitting well-crafted appeals to insurance carriers will be a core function, aimed at securing maximum reimbursement for services rendered.
• • You will proactively identify billing errors at various stages of the revenue cycle and coordinate with relevant parties to ensure these errors are corrected before claims are resubmitted, preventing future payment delays.
• • Thorough and accurate documentation of all follow-up actions, payer communications, and account activities within the system is paramount, providing a clear audit trail and supporting efficient team collaboration.
• • You will engage in direct communication with insurance representatives to verify claim status, formally request reconsiderations for disputed claims, and effectively escalate unresolved issues to ensure timely resolution.
• • Maintaining high daily productivity and adhering to stringent quality assurance standards, as defined by management, will be essential to your success and the team's overall performance.
• • Beyond routine claim follow-up, you will contribute to backlog projects, which may include 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 specific payer policies, identifying emerging denial trends, and developing effective follow-up strategies.
• • Active participation in team projects and a commitment to continuous process improvement initiatives will be encouraged, fostering a culture of learning and efficiency.
• • Upholding the highest standards of confidentiality and protecting patient health information in strict compliance with HIPAA (Health Insurance Portability and Accountability Act) and other relevant regulatory standards is non-negotiable.
• • Staying consistently updated on evolving payer guidelines, reimbursement policies, and regulatory changes within the healthcare billing landscape is crucial for maintaining compliance and maximizing revenue.
• • This role offers the opportunity to leverage your Cerner expertise in a remote setting, contributing significantly to the revenue cycle management of hospitals across the US.