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Insurance Billing and Follow Up Specialist II

To us, it's about living life to the fullest while serving our patients, teammates, neighbors and friends. We are dedicated and passionate in everything we do, seeking challenge and appreciating the routes that got us here. Whether our path is clinical or not, we all came to find balance and meaning in our lives within the work we are passionate about and the adventures we live.

Vail Health has become the world’s most advanced mountain healthcare system. Our updated 520,000-square-foot hospital opened in December 2020.  This state-of-the-art facility provides exceptional care to all of our patients, with the most beautiful views in the area, located centrally in Vail.

Pay Range: Min: $20.00 Max: $27.83. Pay is based upon relevant education and experience.
 
$2,500 Sign On Bonus Available!
 
POSITION PURPOSE:

Prepares and submits claims. (Institutional and Professional). Proficient at management of assigned inventory with the ability to work
in an alternate inventory as required for coverage. Follows-up on insurance claims within required timeframes as identified in the Essential Job Functions.

ESSENTIAL JOB FUNCTIONS: 

  1. Accurately prepare and submit claims in the work queue within the required time frame afternoon billing information is available,
    following all organization, payer and regulatory guidelines. (Institutional and Professional). Proficient at management of assigned
    inventory (multiple service lines).
  2. Follow-up on insurance claims within 30 days of billing for commercial payers and 21 days of billing for government payers. Maintain
    ATB for assigned accounts > 90 days from discharge at <28% of total AR. Monitor KPI’s and report weekly/monthly as required.
    Obtain additional information from patient/guarantor as needed for claims processing.
  3. Submit claims edits to CDM specialist or HIM coder queue as appropriate based on code origination.
  4. Respond to Customer Service inquiries within 48 hours of request.
  5. Review and process assigned correspondence daily. Process denials and appeals at a minimum weekly.
  6. Expedite resolution for denial and rejected claims, referring these to the immediate supervisor when > 3 attempts are made without
    claims adjudication
  7. Obtain additional information from patient/guarantor as needed for claims processing.
  8. Contribute to department process improvement activities
  9. Model the principles of “Just Culture”.
  10. Performs other duties as assigned. Compliant with HIPAA, The Joint Commission and other regulatory agencies as required. 

This description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

MINIMUM QUALIFICATIONS: 
 
Experience:
  • Two years healthcare financial experience required.
  • Prior Hospital or physician billing experience strongly preferred.
License(s):
  • N/A
Certification(s):
  • Certified Patient Financial Services Certification (HBI) or comparable years of experience (>2years) preferred.
  • Certificate in healthcare billing and coding preferred. 
Computer / Typing:
Must have working knowledge of Microsoft products. Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.
 
Must have working knowledge of the English language, including reading, writing, and speaking English.
 
Education:
  • N/A

 

Benefits at Vail Health 

  • Competitive Wages & Family Benefits: Competitive wages, parental leave, housing programs and childcare reimbursement to support the cost of living in a mountain community.
  • Comprehensive Health Benefits: Top-quality health care package including vision, dental and medical with options of flexible spending and health savings accounts.
  • Education Assistance: We are proud to offer tuition and student loan assistance programs.
  • Paid Time Off: Roughly five weeks in your first year of employment and continues to grow each year.
  • Retirement & Supplemental Insurance: 403(b) Retirement plan with matching potential, life insurance, short and long-term disability, and more.
  • Recreation Benefits, Wellness & More: Recreation discounts, pet insurance and a $1,000 annual wellness reimbursement program.

 

As a condition of employment, Vail Health requires COVID-19 vaccination of all clinical and non-clinical staff.

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