Insurance Billing Collections Assistant III (Remote) - Neurology

📋 Description

• • Serve as the senior-level Insurance Billing Collections Assistant for Washington University’s Neurology service line, owning the full revenue-cycle follow-up for high-dollar physician claims across commercial, Medicare, Medicaid, and third-party liability payers. You will act as the last line of defense before bad-debt placement, using advanced Epic workflows, payer portals, and analytical reports to recover aged receivables and protect departmental cash flow.
• • Drive daily, metrics-based collections by independently managing a portfolio of 1,000+ complex claims valued at $2.5M+; prioritize accounts by aging buckets, denial reason codes, and expected reimbursement to achieve a rolling 90-day cash target of 96 %.
• • Execute sophisticated insurance follow-up tactics: interpret EOBs, RA/835 files, and denial letters; craft concise, evidence-rich appeals with CPT/ICD-10, modifier, and medical-necessity documentation; submit corrected claims, reconsiderations, and redeterminations within payer deadlines to overturn denials and secure maximum allowable reimbursement.
• • Conduct professional, HIPAA-compliant telephone and written outreach to carriers, attorneys, and patients—averaging 40–50 outbound contacts per day—probing root-cause issues, negotiating payment plans, and documenting every interaction in Epic comments for seamless audit trails.
• • Validate and correct demographic, insurance, and authorization data in real time; leverage real-time eligibility, prior-auth, and referral modules to prevent future denials and reduce rework by 15 % quarter over quarter.
• • Mentor and cross-train junior staff on collections best practices, payer-specific rules, and one-touch resolution techniques; may serve as Team Lead during supervisor absences, assigning daily work queues and conducting first-level QA reviews.
• • Partner with Neurology coders, prior-auth specialists, and clinical documentation integrity teams to identify systemic trends—such as bundling edits or LCD/NCD conflicts—and recommend process fixes that permanently increase clean-claim rates.
• • Generate ad-hoc Excel or Epic reports (pivot tables, V-lookups, and Power BI dashboards) to visualize denial patterns, payer scorecards, and collection forecasts for management; present findings in weekly huddles and recommend targeted action plans.
• • Support the front-end customer-service unit by acting as escalation point for patients calling with billing questions; translate complex EOB language into plain terms, set up payment arrangements, and route charity-care applications to financial counselors.
• • Participate in special projects such as new-payer implementations, system upgrades, or audit preparations; test claim formats, validate remittance mapping, and update departmental standard operating procedures to ensure continuity of cash collections.
• • Maintain strict compliance with university, federal, and state regulations (HIPAA, CMS, MO insurance statutes); safeguard confidential data, complete annual compliance training, and participate in payer or regulatory audits with zero findings.
• • Model WashU’s core values—respect, integrity, and collaboration—while working 100 % remotely from any Missouri location; maintain secure home-office setup with dual monitors, VPN, and university-approved peripherals to ensure uninterrupted productivity.