Pay Range Minimum
Job Code:

*This is a Non-Exempt position. Employees in this position are paid an hourly pay rate, on a bi-weekly basis, and are eligible to receive overtime pay for any hours worked over 40 in a work week.

JOB DESCRIPTION: Responsible for assigned billing and accounts receivable functions of comprehensive, high complexity, to include, Denials Management, Insurance Follow Up, Claims Processing, Appeals, Charge Corrections, special projects and related front-end edits. Provides support to leadership facilitating quality improvements by reporting problems, concerns and opportunities for increased revenue and decreased denials. Effectively plan daily workload to ensure maximum efficiency and production. Ensures timely adjudication and resolution of medical insurance claims filed with payers to maximize reimbursement of claims. Utilizes advanced problem-solving skills to resolve outstanding accounts receivables. Serves as the point person/lead for employee questions. Duties: Verifies and updates patient demographics and registration information on accounts. Submit claims electronically as required. Utilize payer portals to status claims; follow through to adjudication. Works independently to resolve issues, applying root cause analyses to determine steps required for timely resolution. Maintain knowledge of current governmental and third party payers billing guidelines and knowledge of insurance plans and contracts. Works high complexity front-end edits; requires the ability to effectively navigate various systems, programs and electronic medical records and the ability to perform outreach to communicate identified issues and trends. Demonstrated knowledge of medical terminology, and payer specific healthcare billing and reimbursement guidelines. The ability to communicate effectively and professionally in interactions with customers, management and peers. Must be able to work collaboratively and positively within a culturally diverse production environment. Proficiency in healthcare insurance billing, reimbursement and coding guidelines. Perform other duties as required in support of departmental goal achievements. Proficiency with Microsoft Office.
MINIMUM QUALIFICATIONS: A high school diploma or equivalent and 3 years of billing and collections experience in a healthcare or insurance environment or 2 years college/technical school and 2 year progressive experience. Preferred Qualifications: Knowledge of GE Centricity Business Practice Management System, and related modules. Knowledge of EPIC EeMR. Strong analytic skills. Proficiency with Microsoft Office.

The above statements are intended to describe the work being performed by people assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of the personnel so classified.


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