Claims Management: Monitoring and working Epic Claim Edit work queues. This may include Epic Charge Review & Charge Router review WQs based on UCSF Health standard work. Correcting Epic and clearinghouse claim edits, rejections and submitting claims Processing and submitting paper claims as necessary Submitting claims with medical records or other attachments as needed (Electronic & Paper) Insurance A/R Follow-up Validating claim receipt/status (including any claims that had to go out on paper) Reviewing & resolving reason for unaccepted/rejected claim from payor Completing payor follow-up for both Commercial and Government payors including: Follow-up on accounts where no response has been received from the payor Follow-up on denied accounts (see further detail under denial management), including contacting payors, reviewing contract terms provided, cross walking CPTs codes based on client instruction Denial Management Review and appeal denials Partner with UCSF Health coding and operations teams to resolve coding denials and denials needing operations input Review and address underpayment issues Cash posting for all payor and patient payments (electronic and manual) Balancing of collections in office and electronic payments Adjustment posting (able to follow client provided adjustment guidelines for administrative & controllable write-offs)
