Full job description Love + medicine is who we are, it's what we do, it's why people want to work here. If you're looking for a job to love, apply today. Scheduled Weekly Hours:
40 Job Description: This position will be responsible for performing detailed audits of guarantor accounts to identify and rectify billing issues/problems. They will be responsible for follow up with Third Party Payors for reimbursement and final disposition of claims. They will investigate, initiate and resolve claim reviews and appeals with Third Party Payors.
Major Responsibilities:
1. Works collectively with payors, patients and internal contacts to identify and rectify billing issues resulting in reimbursement and final disposition of claims. Verifies accuracy of payment for correct reimbursement.
2. Maintains knowledge of all regulations by continually enhancing education specific to federal regulations, payer communications, federal registers and contractual guidelines to ensure compliance. Is familiar with government and commercial Web Sites and can research and interpret them effectively.
3. Works with our internal and external customers to maintain data integrity within patient accounting systems.
4. Works closely with Customer Service, Patient Relations, Risk Management, and Provider Medical Management to provide direction with complicated account inquiries to provide accurate and timely responses to patients resulting in increased overall patient satisfaction. Uses CWS to view patient preferences to communicate with patients including those cared for by Behavioral Health.
5. Performs complex guarantor account reviews on all financial classes including credit balances. Investigates and appeals denials from Third Party Payors by verifying accuracy and compliance submission. Performs necessary error corrections and/or initiates a refund request to rectify the guarantor account. Documents all activities/actions taken on an individual patient account within the billing system.
6. Must be familiar with appropriate regulatory and contractual guidelines including HIPAA, in order to review and make corrections as appropriate.
7. Effectively communicates and educates patients on their financial responsibilities to the organization by giving estimates on services, taking payments, setting up payment arrangements and negotiating settlements on accounts under direction of Supervisor/Manager/Director. This would include the guidelines for payments and self pay balances, along with the insurance process and statements they will receive.
8. Actively participates in analysis of work processes and provides feedback to the PBS Managers and PBS Systems Trainers to assist in enhancing overall patient satisfaction and work process improvements.
9. Participates actively in department meetings, and assumes additional responsibilities and special projects as assigned.
10. Determines appropriate insurance eligibility and rebills claims with new information. Contacts and works directly with patients when necessary.
11. Identifies and routes to appropriate staff for solving Charge Master Issues.
12. Requests refund checks for overpayments to third party payor or patient if appropriate. Notifies insurance company to recoup payment if required by contract.
13. Identifies issues with ERN files. Involves PBS Systems, Payment Posting and appropriate staff to resolve and problem solve. Involves IS when necessary. Provides appropriate information and feedback.
14. Account Receivable Reps will utilize the Chart Review function within Epic to better assist patients and clinical departments to compile and communicate estimates related to financial costs for services/treatments rendered.
Education and Learning:
REQUIRED
High School Diploma or equivalency
Successful completion of defined core competency testing for Accounts Receivable Representatives.
DESIRED
High School Diploma or equivalency + additional training
Work Experience:
REQUIRED
1 year work experience, preferably working in a medical facility, insurance company or office setting.
DESIRED
1 year experience in a healthcare setting with claims billing to Third Party Payor.
Age Specific Population Served:
Nonage Specific (N/A)
OSHA Category:
Category III - No employees in this job title have a reasonably anticipated risk of occupational exposure to blood and/or other potentially infectious materials.
Environmental Conditions:
Not substantially exposed to adverse environmental conditions (as in typical office or administrative work).
Physical Requirements/Demands Of The Position:
Sitting Continually (67-100% or 8 hours)
Static Standing Occasionally (6-33% or 3 hours)
Walking/Standing Occasionally (6-33% or 3 hours)
Stooping/Bending Occasionally (6-33% or 3 hours)
Kneeling/Half Kneel Occasionally (6-33% or 3 hours)
Reaching - Shoulder Level Occasionally (6-33% or 3 hours)
Reaching - Above Shoulder Occasionally (6-33% or 3 hours)
Repetitive Actions - Fine Manipulation Frequently (34-66% or 5.5 hours)
Lifting - Floor to Waist Occasionally (6-33% or 3 hours)
Lifting - Waist to Overhead Occasionally (6-33% or 3 hours)
Lifting - Other Occasionally (6-33% or 3 hours)
If you need assistance with any portion of the application or have questions about the position, please contact the recruiter listed below:
Primary Recruiter:
Jenni Elsbernd Recruiter Email Address:
Equal Opportunity Employer
