JOB SUMMARY:
The Retro Billing Associate reviews bills submitted by payors and channel partners via One Call’s retrospective program. Associates follow state and federal guidelines, fee schedules, and customer-specific rules to obtain enhanced savings for our clients. Associates interact with Providers and Claim Professionals as necessary to deliver accurate and efficient bill processing. Communicates timely responses to inquiries from Internal and External customers.
ESSENTIAL DUTIES & RESPONSIBILITIES:
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Learns or remains current on billing protocols and regulations, federal and state regulations, and internal procedures that affect processing.
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Provides subject matter expertise on billing and coding guidelines and regulations as required by the department.
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Uses internal and external billing protocols and regulations for repricing bills at a cost savings to the customer.
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Identifies trending opportunities related to policies and procedures to ensure efficiency and accuracy in bill processing.
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Reviews, researches, and initiates the resolution of billing errors.
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Reviews, researches, and resolves customer-related inquiries.
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Develops/maintains process documentation for each assigned task.
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Communicates with appropriate internal departments to solve issues and discrepancies.
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Performs other related duties as assigned.
EDUCATIONAL AND EXPERIENCE REQUIREMENTS:
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High school diploma/GED required.
ESSENTIAL KNOWLEDGE, SKILLS & ABILITIES:
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Knowledge of Billing rules and regulations and federal and state regulations.
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Excellent customer service skills that build high levels of customer satisfaction.
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Effective verbal and written communication skills.
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Computer navigation and operation skills.
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Detail-oriented with good organizational skills.
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Ability to manage multiple tasks.
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Ability to work both independently and in a team environment.
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Ability to maintain confidentiality.
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Proficient with Microsoft Office.
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Ability to work in an environment that aligns with the company's diversity, equity, inclusion and belonging standards.
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Ability to work both independently and in a team environment.
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Demonstrate our core values of Think Big, Go Fast, Deliver Awe, and Win Together.
PHYSICAL/MENTAL DEMANDS & WORK ENVIRONMENT:
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This position will be performed in the colleague’s home. Work-from-home requirements include the colleague’s ability to set up computer equipment within their home office.
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This job is primarily sedentary and may involve repetitive motions; the colleague must be able to remain in a stationary position for extended periods of time, operate a computer and other office equipment, assess information and files stored electronically, and converse/exchange accurate information with others, simultaneously.
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The colleague must be able to discern text displayed on a monitor, input data into specific fields using a keyboard, and adjust focus to distances of up to three feet.
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The colleague must have the ability to learn new tasks, follow established processes, maintain focus, complete tasks independently, complete multiple tasks simultaneously, communicate professionally with colleagues and customers, and complete tasks in situations that have a speed or productivity requirement.
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The colleague must be able to manage moderate to significant mental stress as a result of, but not limited to, a dynamic and heavy workload.
Please be advised that job descriptions typically change over time as business needs, job requirements, and employee skill levels change. As such, One Call retains the right to change or assign other duties to this position at any time.
Retro Billing Associate I
Entry level role. Basic skills with moderate level of proficiency. Resolves routine questions and problems; refers more complex issues to higher levels. Consults with senior peers and team leads on non-complex issues to learn through experience. Works under close supervision without latitude for independent judgment. Follows standard procedures and written instructions to accomplish assigned tasks. Requires a High School diploma and typically less than 1 year of experience in an office setting and/or billing experience.
