To facilitate accurate Professional Provider credentialing, billing, posting, and collection for ProMedica Physicians and all other supported entities.

ACCOUNTABILITIES

*All duties listed below are essential unless noted otherwise*

1. Accurate and timely credentialing intake for all supported providers with hospital privileges, payor/plan credentialing, certifications, and regulations.

2. Acts as a liaison between providers/office staff and hospitals or payor plans.

3. Accurately maintains provider information in credentialing software.

4. Timely responses to Onboarding providers/plans/hospitals for intake of new providers.

5. Accurately and timely input of billing information into the practice management system for payment.

6. Accurately reviews and updates demographic and insurance information in the practice management system.

7. Perform a variety of registration, billing, follow up and collection functions for all payers including self-pay.

8. Verify insurance benefits, limits, and patient obligations.

9. Contact patients for necessary information pertaining to registration, billing, and collection.

10. Processes electronic remittance advice as well as manual posting files upon receipt from the bank.

11. Reviews and resolves clearinghouse edits and identifies opportunity to build up front edits in the practice management system.

12. Works with clearinghouse on payor registrations and issues.

13. Works with internal departments to obtain information for external requests including refunds.

14. Reviews debits, credits, refunds, bad debt and contractual allowances for accuracy and processes as applicable.

15. Knows and follows all billing regulations and corporate compliance plans.

16. Provide feedback to management on issues that impede timeliness or quality of billing and work with management to resolve.

17. Maintains current payor knowledge for effective claims management and follow up of unresolved claims.

18. Routinely reviews workflows for process improvement and efficiencies and provides feedback to management for implementation of changes.

19. Independently reviews assigned workloads and completion to ensure goals are being met.

20. Perform other duties as assigned.

Location: Remote