Professional Billing Claims Follow Up Rep II

✔ Own the Professional Billing Lifecycle

• Prepare, review, and submit accurate professional claims using Epic and payer-specific tools.
• Scrub claims to ensure correct codes, units, modifiers, authorizations, and documentation are present before submission.
• Review and resolve edits, rejections, and payer error responses including coding inconsistencies or missing information.

✔ Lead Payer Follow-Up & Claims Resolution

• Conduct timely follow-up with insurance carriers to resolve outstanding claims.

• Investigate denials (technical and clinical), coordinate corrections, and resubmit claims as needed.
• Identify trends in payer behavior to reduce preventable denials and accelerate reimbursement cycles.

✔ Deliver High-Quality Financial Accuracy

• Process, post, and balance payments, adjustments, and payer responses with precision.
• Monitor accounts receivable and escalate complex claim issues using established workflows.
• Support charge review and address discrepancies proactively to avoid downstream billing issues.

✔ Strengthen Billing Operations & Systems

• Maintain and update provider, payer, and billing templates in departmental systems.
• Assist with charge master maintenance to ensure accuracy and competitiveness.
• Support system updates and workflow enhancements that improve billing efficiency.

✔ Collaborate Across the Organization

• Partner closely with clinic teams, coding, Physician Billing Services, Admitting, Financial Services, Payer Relations, and others to ensure complete and compliant claims.
• Provide guidance to peers and act as a resource for non-routine billing functions.
• Support onboarding of new team members as a preceptor or subject matter resource when needed.

Why This Role Matters

Professional billing is complex — but the stakes are high. Your attention to detail helps:

• Secure reimbursement that sustains Cincinnati Children’s world‑leading care
• Ensure providers are paid accurately for their work
• Reduce stress and uncertainty for families
• Enhance compliance and avoid preventable revenue loss

Your expertise contributes to a revenue cycle that operates with integrity, efficiency, and compassion.

About Us