Demonstrates compliance with Code of Conduct and compliance policies and takes action to resolve compliance questions or concerns and report suspected violations.
Manages new accounts, on a daily basis, by working within Receivables Workstation. Interfaces with other departments within the hospital, when appropriate, to obtain information necessary to process or resolve claims. Contacts patient and/or account guarantor to solicit payment on account.
Works all accounts listed in the Follow-Up queue, on a daily basis to promote collection of accounts. This will include telephoning the payer, messaging, or identifying the claim on the payers’ Internet websites.
Manages account inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.
Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.
Processes incoming correspondence, including signature letters, denials, prior authorizations, and additional information necessary to process the claim.
Records newly identified insurance plans and facilitates the account processing of new plan in accordance with pre-billing policies and procedures.
Records accurate and definitive notes in the electronic account file that depict the status of account, issues with account and anticipated date of resolution.
Escalates account management to Supervisor when issues arise, if needed.
Ensures PFS management is kept up to date with contract, payer or system changes and/or issues.
Assigns a status code to each worked account to enable account tracking, statistical data gathering and audit activities.
Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance.
Handles special projects as directed by management e.g. high dollar accounts, accounts over 180 days old, etc.
Maintains productivity standards by payer assignment.
Reviews denial, payor rejection, and any other necessary reports to determine strategy in decreasing payor denials, clearing house rejections and delayed payments
Manages Commercial Insurance, Medicare credits and Medicare quarterly credit balance reports to ensure timely resolution of refunds and balance rectification.
Manages priority account inventory in a timely manner to promote payment and resolution of all accounts as instructed by management.
Regularly analyses account inventory aged greater than 90 days to promote payment and resolution of all accounts to decrease AR days.
Provides analysis on aged inventory for future checks and balances and timely resolution to PFS Management Staff and Director.
Processes incoming hard copy explanation of benefits and reacts appropriately to resolve the accounts.
Obtains and records “Promise to Pay” amounts daily that are consistent with the cash collection goals.
Identifies work unit issues and participates in solutions and problem solving by working with supervisor and staff members.
Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.
Participates in Payer webinar and training sessions to maintain latest knowledge on billing, coding and reimbursement practices, monitors updates with Insurance Payers and relays information to management, trainers and co-workers effectively.
Performs other job-related tasks as assigned.
Experience:
Required: Three (3) years of experience in medical billing or collections
Preferred: Experience with managed care and Medicare/Medi-Cal Billing regulations
1 year billing/collections experience, patient financial service setting
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Seniority level
Mid-Senior level
Employment type
Full-time
Job function
Other
Industries
IT Services and IT Consulting
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