Description:
- Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
- Under general supervision, is responsible for processing insurance and billing insurance in a timely manner
Responsibilities:
- Adheres to all rules and regulations of all applicable local, state and federal agencies and accrediting bodies
- Works with Insurance payers to ensure proper reimbursement on patient accounts
- Depending on payer contract may be required to participate in conference calls, accounts receivable reports, compiles the issue report in order to expedite resolution of accounts
- Examines contract to ensure proper reimbursement, educates team of inconsistencies in processing, including disciplinary discussions if necessary, and any changes to contract identified
- Works follow up report daily, maintaining established goal(s), and notifies Supervisor, of issues preventing achievement of such goal(s)
- Follows up on daily correspondence (denials, underpayments) to appropriately work Patient accounts
- Assists Customer Service with Patient concerns/questions to ensure prompt and accurate resolution is achieved
- Produces written correspondence to payors and patients regarding status of claim, requesting additional information, etc.
- Reviews previous account documentation, determining appropriate action(s) necessary to resolve each assigned account
- Initiates next billing, follow-up and/or collection step(s), this is not limited to calling patients, insurers or employers, as appropriate
- Sends initial or secondary bills to Insurance companies
- Documents billing, follow-up and/or collection step(s) that are taken and all measures to resolve assigned accounts, including escalation to Supervisor/Manager if necessary
- Processes administrative and Medical appeals, refunds, reinstatements and rejections of insurance claims
- Remains in consistent daily communication with Team members, including new process education, disciplinary actions, Reimbursement Lead and Reimbursement Manager regarding all aspects of assigned projects
- Monitors and assists team members regularly, providing feedback, ensuring both goals and job requirements are met as assigned by Manager
- Trains new staff, performs audits of work performed, and communicates progress to appropriate Supervisor
- Provides continuing education of all team members on process and A/R requirements
- Adheres to HIPAA regulations by verifying pertinent information to determine caller authorization level receiving information on account
Knowledge and Skills Required:
- Ability to use discretion when discussing personnel/patient related issues that are confidential in nature
- Ability to be responsive to ever-changing matrix of hospital needs and act accordingly
- Typing skills equal to 20 words per minute net
- Proficiency in performance of basic math functions
- Ability to communicate professionally and effectively in English, both verbally and in writing
- Proficiency in Microsoft office products such as Word and Excel
- Strong analytical and research skills
Education and Experience Required:
- 1 year experience in Revenue Cycle Department or related area (registration, finance, collections, customer service, medical, contract management)
Education and Experience Preferred:
- High school diploma or GED