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POST DATE 8/11/2016
END DATE 10/13/2016
Responsible for the duties and services that are of a support nature to the TLRA Work Team. Ensures that all processes are performed in a timely and efficient manner. Performs assigned duties such as responding to incoming patient calls, client reporting and communication, updating account information, documentation, research, correspondence, filing, verification of insurance coverage and benefits and submission/billing of hospital claims. Provides thorough courteous and professional assistance to patients, physician offices, insurance companies and other clients on an as needed basis while maintaining strictest confidence. This position is expected to have solid knowledge of all TLRA's business lines and services, internal operational procedures for all areas and collection system functionality.
- Ensure daily productivity standards are met.
Ensures quality standards are met and proper documentation regarding patient accounting records
Ensures all correspondence, rejected claims and returned mail is worked within 48 hours of receipt (allowing for weekends and holidays). Ensures business requests are worked and documented within 24 hours of receipt.
Maintains an active working knowledge of all billing and reimbursement requirements by Payer. Continuously receives updates and information regarding changes and newly revised billing and reimbursement practices and ensures compliance.
Documents and tracks request for account information timely and accuraely.
Maintains an active working knowledge of all Governmental Mandated Regulations and Non-Government Payor Regulations as it pertains to claims submission. Responsible to perform the necessary research in order to determine proper governmental requirements prior to claims submission.
Handles request for rebills, detail bills and itemized statements and forwards informaton to appropriate party as documented. This includes determining appropriate method of claim submission (i.e. hardcopy vs. electronic) and modifies/completes the hospital claims genration fileds accordingly.
Provides support services for the legal unit to include documetnation of bankruptcies, liens, and requestiong legal documents by account as approved.
- Performs insurance verification on all new insurance information obtained, documents and updates systems as accordingly as well as ensuring account status/location is updated appropriately.
Client Services Liaison
Acts as the Client Liaison for all of TLRA's cleints and busines srevices to respond to inquiries, handle request for infromation, resolve issues or problems.
Handles all inbound client calls and request promplety and professionaly.
Handles patient account recalls received from the client to include logging information and documentation of the collection system. Ensures timely notification of potential problems or issues related to recalls to appropriate personnel.
Provides effective and timely communcation and education to both clients and associates for issues reflated to TLRA busines services and service level expectations.
- Compiles and distributes client performance reports, client statements and requested custom reports to clients in timely manner.
- Runs online reports and transactional analysis to support positive outcomes for both client and TLRA service areas. Provides ongoing support in resolving inventory issues impacting client performance.
- Screen and identify self-insured, uninsured, underinsured patients for eligibility of approved discount and/or charity.
- Work as patient advocate to assist patients with financial applications process and conducts phone interviews with patients to obtain information relevant to eligibility process.
- Knowledge of individual client processes and procedures as well as systems directives that pertain to charity care processing (Management Directives, Policies and Procedures, etc.).
- Processes presumptive charity for TLRA based upon established procedures, this includes identification of qualified accounts, account processing and obtaining appropriate approval based upon thresholds.
- Compile comprehensive charity reporting package to include projection, trending and tracking reports.
- Provide effective and routine communication and reporting to TLRA leader that identifies opportunities for improvement, problem resolution and enhancements for TLRA services.
- HS Diploma or equivalency required
- Post HS education preferred
- B. Experience
- Must have minimum of 2 years' experience in a Customer Service call enter environment with a focus on healthcare billing/collections or collection agency environment or 2 years' experience working in a client service or marketing capacity, preferably in a healthcare or collection agency environment.
- General hospital A/R accounts knowledge is required.
- PC skills in a Windows environment are required. Solid knowledge and utilization of desktop applications to include Word and Excel are essential. .
- College education, previous Insurance Company claims experience and/or health care billing trade school education may be considered in lieu of formal hospital experience.
C. Licenses, Registrations, or Certifications