Summer Hughes

Review Corporate Compliance Audits to determine the necessary corrections/actions needed. If corrective action is needed, make the necessary correction at the account level and rebill the account to the intended payer. Work with the refund team to ensure refunds are submitted to insurance/patient correctly.

Provides direction and support for staff, promotes staff development and collaborates with leadership. Responsible for handling and solving any problems related to their area of assignment as well as hiring, coaching and termination of assigned staff, as appropriate. Conducts and oversees the orientation, training and mentoring of all employees. Responsible for performing the revenue cycle tasks that are necessary to ensure compliance and excellent customer service.

Submit primary and secondary claims to Medicare, Medicaid, Managed Care and Commercial payers for reimbursement. Provide assistance and support to teammates regarding questions on how to accurately handle accounts. Review Clinical Trial/Research accounts to ensure all information needed is posted to the account for proper claims handling.

Submit claims to commercial payers for reimbursement. Print medical records and mail with claims for Workers compensation review. Review reports for accounts discharged but not billed, and resolve any pending issues in order to generate claims.

Generate and submit claims to Medicare for Duke University Hospital, Durham Regional Hospital, and Duke Raleigh Hospital. Submit adjustment claims to Medicare timely and ensure all information is correct. Initiate and develop relationships with internal customers in order to gather and process information or resolve issues in order to receive accurate reimbursement.

Update insurance information and file claims to primary and secondary insurances. Provide information to callers inquiring about their laboratory invoices including explaining insurance denials and the proper procedures needed in order for insurance to reprocess claims.

Perform routine billing functions accurately and efficiently. Investigate and resolve billing problems and assist other department with billing issues. Correct Medicare error and hold reports for assigned facilities.

Submit billing to Medicaid on a weekly basis for residential services. Submit billing to LME’s on a monthly basis for room and board and CBS services. Follow up with Medicaid and/or LME’s on billing issues to determine requirements for payment.

Act as liaison between area mental health provider and various insurance agencies to obtain and monitor authorizations for specified services. Review the IPRS denials in order to locate and rectify errors that prevent reimbursement. Perform weekly and/or random audits of medical records.

Bill commercial insurances and third party payers – research, audit charges, and confirm doctors’ orders and billing authorizations. Post payments to accounts and send out self pay bills. Address patients’ concerns such as co-payment and/or deductible amounts that are pending.