William Ivi

• Ensure PFS departmental quality and productivity standards are met.

• Maintains working knowledge of all functions within the Revenue Cycle.

• Responsible for professional and effective written and verbal communication with both internal and external customers in order to resolve outstanding account resolution.

• Meets or exceeds customer expectations and requirements, and gains customer trust and respect.

• Review and respond to insurance/patient correspondence timely

• Keeps current with knowledge of professional payer contracting agreements

• Exhibits a strong working knowledge of CPT, HCPCS and ICD-10 coding regulations and guidelines.

• Appropriately documents patient accounting host systems or other systems utilized by PFS in accordance with policy and procedures

• Identifies and forwards proper account denial information to the designated departmental liaison. Dedicates efforts to ensure a proper denial resolution and timely turnaround.

• Identify and resolve underpayments with the appropriate follow up activities within payer timely guidelines.

• Identify and resolve credit balances with the appropriate follow up activities within payer timely guidelines.

• Audits and reviews daily tasks to ensure accuracy and completeness prior to end of work shift. Balances and closes batches in a timely manner.

• Maintained professional relationships with various insurance companies while advocating on behalf of the organization's interests.
• Worked collaboratively with other departments to ensure accurate follow-up processes were followed.
• Initiated appeals when necessary for denied or underpaid claims as required by contract guidelines.
• Researched and resolved insurance discrepancies for assigned accounts.
• Developed strategies to maximize revenue collection from third party payers through timely resolution of outstanding balances due from insurers.
• Generated reports detailing delinquent accounts receivable balances, aging analysis, denials and rejections.
• Followed up with insurance carriers regarding claim status of unpaid or rejected claims.
• Analyzed provider contracts to determine proper coverage of services rendered by providers.
• Ensured that all documentation was accurate and complete prior to submitting claims for payment consideration by the insurance company.
• Identified and corrected errors related to billing, coding, and reimbursement from insurance companies.
• Utilized multiple payer websites to obtain detailed information about benefit eligibility and coverage levels.
• Responded promptly to inquiries from internal staff members and external customers regarding account status updates.
• Excelled in exceeding daily credit card application goals.

• Autonomously research, initiate follow-up and resolve all health care
  insurance claim accounts with existing credit balances (claim(s) paid more
  than expected by payer); actions included but not limited to initiating refund packets, retractions, and/or adjustments to claims.
• Navigate through various payer systems and multiple internal systems to
  ensure timely and accurate resolution of claims.
• Use critical thinking, root cause analysis, and problem-solving skills to
  resolve issues on outstanding claim balances.
• Uses strong organizational skills to effectively manage large amounts of
  detailed information.
• Utilizes excellent written and oral communication skills to collaborate and
  maintain positive working relationships with peers, leaders, clinical
  personnel, and payer representatives to resolve credit balances.
• Contributes to implementation of process improvement initiatives aimed at
  improving credit department.
• Ensures compliance by using established internal control procedures by
  examining records, reports, operating practices, and documentation.
• Stay current on communications relating to healthcare reimbursement and
  regulatory changes.
• Maintain confidentiality of all company and patient information in
  accordance with HIPAA regulations and client's policies.
• Understand and adhere to all policies, laws and regulations applicable to
  this role.
• Consistent, regular, punctual attendance as scheduled is an essential
  responsibility of this position.
• Participate in group settings and teamwork environment.
• Responsible for all aspects of follow-up and collections, including making
  telephone calls, and accessing payer websites.
• Collects and provides patient and payer information to facilitate account
  resolution.
• Responsible for performing the necessary research to determine proper
  governmental requirements before claims submission.
• Responds to all types of account inquiries through written, verbal, or
  electronic correspondence.
• Responsible for professional and effective written and verbal
  communication with both internal and external customers to resolve
  outstanding accounts resolution.
• Compliant with all payer and government regulations.
• Collect balances due from payers to ensure proper reimbursement for all
  services.
• Identifies and forwards proper account denial information to the
  designated departmental liaison.
• Dedicated efforts to ensure a proper denial resolution and timely
  turnaround.
• Maintain an active knowledge of all governmental agency requirements
  and updates.
• Demonstrates knowledge of standard bill forms and filing requirements.
• Identify and resolve underpayments with the appropriate follow-up
  activities within payer timely guidelines.
• Identify and resolve credit balances with the appropriate follow-up
  activities within payer timely guidelines.
• Identify and communicate trends impacting account resolution.
• Initiates Medicare Redetermination, Reopening, and/or Reconsideration as
  needed.
• Identify issues or trends and provide suggestions for resolution.