This position involves specific and accurate review of accounts that were denied payment and will include following up
with insurance companies, reconciling of accounts, filing corrected claims, appealing claims when appropriate, and
following up on all denials to ensure reprocessing and payment in a timely manner. This individual will have knowledge of
how to review WPH payor contracts to assure how claims should process and pay, have the ability to navigate review of
the claim to determine any issues that may need correction. Ability to discuss claims with insurance representatives to advocate for the denials that were performed inaccurately to assure prompt payment.

Essential Functions and Responsibilities Includes the Following:
1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors.
2. Process rejections, denials and other correspondence received from third party payers
3. Resolve non-payment issues to assure accurate rebilling, when needed
4. Ability to navigate WPH payor contracts for accurate information needed to determine non payment issues
5. Ability to navigate EMR, facilitating necessary actions internally to assure claim moving through system
accordingly
6. Ability to speak with payor representative to discuss any denial issues, whether erroneously denied or
determining needed updates on the claim
7. Reporting trends and claim issues to leadership in order to stop issues identified based on review
8. Understanding of codes, billing rules and regulations
9. Responsible for the submission of appeals to third party payers in recover additional revenue
10. Must have ability to investigate payer rejections and denials.
11. Ability to work through and decipher all denials (e.g. duplicate claims, timely filing, EOB requests, not medically
necessary).
12. Responsible for reviewing and trending of denial issues, identify root cause and bring accounts to final resolution
and communicating to leadership.
13. Document, communicate and make recommendations for improvement of current processes in order to eliminate
future denials
14. Performs all other related duties as assigned.

Education & Experience Requirements:

• High School Diploma or GED required.
• Previous experience in a hospital setting relating to billing, follow up and denials experience, preferred.
• Medical terminology knowledge, preferred
• Familiarity with electronic medical record systems, EPIC preferred.
• Must be detail oriented, able to problem solve, multi-task and perform various duties on demand.
• Proficiency with Microsoft office/excel to include reporting
• Effective 12/1/2022 the HBI (Healthcare Business Insights) one time certification course is required and must be completed during the onboarding period and prior to start date.s.