JOB DESCRIPTION:
- Assist with departmental workflow as needed.
- Identifies and notifies leadership of issues and initiates appropriate action for resolution.
- Serves as point person for employee questions.
- Maintains thorough understanding of insurance, registration, scheduling, referrals, authorizations, and account follow-up.
- Provides support to leadership facilitating quality improvement by reporting problems, concerns, and opportunities for increased revenue and decreased denials.
- Assists in training and development of new staff members through the quality assurance process.
- Operates standard office equipment including telephone, copier, embossers and fax machine; prepares written correspondence and completes various forms.
- Reviews all accounts assigned for collection prior to, during, or after admission and discharge.
- Obtains demographic and insurance information for preadmission.
- Verifies benefits and pre-registers when appropriate.
- Initiates precertification when necessary.
- Verifies insurance as needed to resolve account balances.
- Obtains necessary financial data to set up patient payment arrangements when needed.
- Completes Financial Statement and gets approval on arrangements exceeding three months to completion.
- Works with staff to ensure best estimates of services.
- Performs progressive collection steps to discuss and clear balances on multiple accounts.
- Researches status of Medicare, Medicaid, and Blue Cross accounts through use of MEDA and BCH, accepted batch listing reports, EOB, and other information.
- Bills third party payors, when appropriate, by hard copy or electronic submission.
- Performs special billing tasks such as combined and split bills as needed.
- Performs collection follow up support on assigned third party accounts.
- Coordinates activity with collections staff to ensure timely, accurate rebill of accounts.
- Inquires about status of payments from insurance carriers.
- Ensures payment is received when expected; immediately pursues billing secondary insurance or billing the patient; applies appropriate allowance and adjustments.
- Recommends adjustments as appropriate to bring timely resolution to accounts.
- Maintains up-to-date knowledge of insurance plans and current contracts, co-payments and deductibles.
- Interfaces successfully with insurance carriers.
- Maintains knowledge of current government and hospital contracts and working knowledge of co-payments and deductibles.
- Maintains and is familiar with UB92 and HCFA Billing Manuals.
- Coordinates classification for bad debt and charity.
- Maintains knowledge and is familiar with Healthquest system.
- Serves as a patient advocate during the cycle of the account.
- Communicates organization's financial policies to patients.
- Identifies patients who require early financial counseling intervention.
- Provides information regarding resources for patients who need financial help.
- Works with manager/supervisor to formulate plan for professional development.
- Attends educational in-services as appropriate.
MINIMUM QUALIFICATIONS:
- High school diploma or equivalent.
- Must have atleast four (4) years healthcare related experience.
- Knowledge of Medicare, Medicaid, and other contract payers (HMO, PPO) preferred.
- CPAR (Certified Patient Account Representative) and/or CPFC (Certified Patient Financial Counselor) preferred for positions in hospital setting.
- Typing skills with a minimum of 35 wpm and good communication skills.
PHYSICAL REQUIREMENTS (Medium Max 25lbs): up to 25 lbs, 0-33% of the work day (occasionally); 11-25 lbs, 34-66% of the workday (frequently); 01-10 lbs, 67-100% of the workday (constantly); Lifting 25 lbs max; Carrying of objects up to 25 lbs; Occasional to frequent standing & walking, Occasional sitting, Close eye work (computers, typing, reading, writing), Physical demands may vary depending on assigned work area and work tasks.
ENVIRONMENTAL FACTORS: Factors affecting environment conditions may vary depending on the assigned work area and tasks. Environmental exposures include, but are not limited to: Blood-borne pathogen exposure Bio-hazardous waste Chemicals/gases/fumes/vapors Communicable diseases Electrical shock, Floor Surfaces, Hot/Cold Temperatures, Indoor/Outdoor conditions, Latex, Lighting, Patient care/handling injuries, Radiation, Shift work, Travel may be required. Use of personal protective equipment, including respirators, environmental conditions may vary depending on assigned work area and work tasks.