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POST DATE 9/3/2016
END DATE 1/28/2017
-Performs Medical collection functions relevant to the Patient Financial Services Department in a manner that meets or exceeds CHRISTUS Health key performance criteria as it relates to cash collections, aged accounts receivables and denials.
-Contact will be made with payers through written correspondence, on-line inquiries or phone to obtain claim status, clarification or to escalate resolution of patient accounts. Exhibits excellent verbal and written communication skills.
- Responsible for researching and resolving accounts. Review proper account handling from admission through self pay collections and applies corrective actions as necessary.
-Understanding of insurance denials and underpayments and routes account to proper department for assistance in resolution. Exhibits excellent problem solving skills.
-Reviews account payment for accuracy utilizing an insurance explanation of benefits, on-line resources or contracts. Determines if balance should be moved to the next responsibility party. Able to resolve credit balances by determining if an account is overpaid or over adjusted.
-Ensures proper reimbursement for all services. All appeals and/or refunds are filed timely in accordance with payer regulations or contracts.
-Responsible to contact CHRISTUS Health facility departments in order to resolve outstanding questions related to account or charge posting information to ensure account integrity and compliance with payer and/or government regulations and to ensure timeliness of follow-up activities.
-Performs rebilling functions as appropriate and exhibits knowledge of UB04 and 1500 bill forms and filing requirements. Exhibits an understanding of CPT, HCPCS and ICD-10 coding regulations and guidelines.
-Understands state insurance laws and the various appeals processes including but not limited to Insurance Commission filings.
-Ensures quality and productivity standards are met. Appropriately documents patient accounting host system or other systems utilized by Patient Financial Services in accordance with policy and procedures.
- Provides continuous updates and information to Patient Financial Services Leadership Team regarding ongoing errors, payer related issues/trends, registration and other controllable QA related activities affecting productivity, reimbursement and/or payment delays.
- Maintains thorough and detailed knowledge of state and federal collection laws, third-party payer claims processing and appeal procedures as well as the different payment methodologies. Ensures compliance with state and federal laws regarding all cash collections activities.
-Functions as a subject matter expert in assisting facility and other Patient Financial Service associates with account and payer related questions.
- Functions effectively within a team and participates and contributes constructively to produce results in a cooperative effort.
-Continually seeks to understand and act upon customer needs, concerns, and priorities. Meets customer expectations and requirements, and gains customer trust and respect.
- Demonstrates ongoing enthusiasm and commitment to the work assigned.
-Works with Supervisor to receive feedback on performance and create a personal development plan.
- HS Diploma or equivalency required
- Post HS education preferred
- B. Experience
- Minimum of two years of experience and excellent working knowledge of insurance carriers' billing regulations and requirements including claims submission, claims follow-up, appeals process, and focused review processes required.
- Experience calculating expected reimbursement according to payer regulations and/or contracts
- Demonstrated success working in a team environment focused on meeting organization goals and objectives required.
- General hospital A/R accounts knowledge is required.
- College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
- Understanding of alternativeBusiness Office financial resources and the ability to provide information and/or recommendations related to these sources of recovery are preferred.