Billing and Revenue Recovery Officer-Billing and Recoveries

Sheikh Shakhbout Medical City

Monitors compliance the rules and the contractual terms and agreement with the insurance companies and DOH Guidelines
Ensures compliance by the facility pricing structure and the rules for the different patient categories (including self-payer) with implementation
Prepares submission for all the patient invoice (Claims) through electronically.
Maintains and report incorrect charges and charges not captured to Team Billing Lead or Billing Manager. Bill all secondary claims processed on a daily basis that is produced by billing system
Ensures that DRG revisions are billed on a timely manner according to the billing policy
Maintains a high level of productivity while maintaining accuracy.
Maintains a working knowledge of all universal billing guidelines for all assigned payers
Assists and works on all HCPCS revisions for rebills daily.
Analysis and rebilling of late charges. Rebilling must be done for all late charges according to current policies
Organizes, negotiate, and communicate clinical claim denials with internal clinical staff and the financial services department, as well as external claims representatives of a variety of insurers
Participates in external payer meetings, presenting payer performance related to denials
Serves as the Subject Matter Expert (SME) for clinical denials documentation and payer clinical guideline
Conducts follow-up on claims unpaid, partially paid or denied, including appeals and resubmission to the insurance company
Maintains claims documentation
Assists in the development of reporting mechanisms to identify trends
Delivers solutions to simpler issues facing the employees and presenting complex issues to the Senior Billing and Revenue recoveries
Corresponds with different vendors for the purpose of account verification and details of payment.
Consults with other disciplines and other ancillary departments (i.e. physician, coding, OR, cardiology, pharmacy, purchasing, case management, respiratory therapy, clinical documentation specialists, etc.) as needed to obtain necessary documentation to support the clinical appeal and implement prevention
Promotes effective communication strategies within the team and maintains interdepartmental liaison where necessary
Manages to work with all stakeholders when identifying trends that can lead to inappropriate denial
Proactively identifies problems and opportunity for improvements related to system usage, training and end user education, practice and user trends and makes recommendations to the Manager of Revenue Recovery for resolution
Identifies, monitors and presents monthly denial performance accompanied with case studies and recommendations for process improvement
Manages to respond to verbal and written inquiries in a timely manner.
Accountabilities
Maintains and creates invoices and billing materials to be sent directly to a customer or patient. Ensures payment history, upcoming payment information or other financial data into an individual account.