Responsible to manage the Third Party Receivable for Paragon claims, to include clean claim submission, follow-up with payors, review of remittance from payor, review of denials and to identify root causes of problems preventing same. Utilize Paragon, Claims Administrator, Horizon Patient Folder and Emdeon applications. 

Edit failed claims in the Claims Administrator system and correct data, revising claim to a passed status for submission to payor for Primary, Secondary, Tertiary, etc. Where required, create multiple claims. If error was due to incorrect information on Paragon, then have revisions made to Paragon and then re-bill account. Alert department responsible for error to avoid errors in future.

Review delinquent error reports, Unbilled Aged Trial Balances to identify reasons claims are held from billing. Satisfy those related to the Billing office. Communicate with the front end departments, i.e.: Patient Access, Ancillary Departments, and Medical Records for edits related to the respective area.

Monitor all related Paragon reports to identify claims requiring combination, sequential or interim billing.

Monitor Late Charge reports daily for rebilling.

Medicare Behavioral Health Inpatients – review available benefits to determine interim billing period.

Charity Care – validate eligibility for service period. Ensure billing data is accurate for recurring account claims.

Review Claims Administrator Reports daily, to monitor the following:

• Claims Imported
• Claims Failed
• Claims Not Imported
• Edit Statistics (Reasons claims failed)

Prepare and perform follow-up for special and client billing for various payors.

Monitor responses from clearinghouse and payors to identify returned claims. Adjust claims accordingly, for resubmission to the payor.

Review Aged Trial Balances for claims in billed status not yet paid. Perform follow-up actions where required. 

Manage receivables by exception. Follow-up on those not paid in accordance with expected reimbursement. Contact payor to discuss payment variances, submit adjustments where necessary. Prepare technical appeals where required. Refer accounts for clinical appeal where required.

Analyze, identify and report areas of high volume error, for enhanced automation opportunity in Paragon or Claims Administrator, or corrective actions in front end areas.

Daily monitor and working of tickler system in Receivables Administrator to include the following:

• Work ticklers generated by system based on path assignments.
• Work ticklers assigned by Claims Management, Management Team and Self Pay teams for payor updates.
• Monitor follow-up on all accounts

Utilize Horizon Patient Folder to monitor and follow-up on hard copy correspondence. Monitor and process all requests for Medical Record documentation.

Monitor claims in Medicare FSS.