Performs daily activities involved in the reimbursement process, i.e. claims filing/follow-up, entry of payments/adjustments, and follow-up on non-payment or payments below contracted fee schedule amount. Identifies any repetitive errors, either system or manual, take corrective action and document. Performs all tasks in a timely manner to ensure consistency in Accounts Receivables (A/R) totals and maintain a minimum of days in A/R. Using internal and external computer systems and payer portals, work traditional Medicare and Medicare Advantage/Replacement inventory to full resolution.
Essential Functions
- Works as part of a multi-disciplinary team to provide answers to inquiries and questions;
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Troubleshoot problems and provide information;
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Handle intervention or referrals with a professional and respectful customer service focus telephonically and/or in person;
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Provides a variety of support services in connection to the day-to-day operations in a health care environment;
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Maintains working knowledge of regulatory guidelines for billing;
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Ability to verify and load insurance coverages correctly for accurate billing;
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Provides claim submission for services provided at SEH;
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Work an resolve claim edits and errors daily;
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Provides follow up on claims which did not process correctly;
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Provides follow up with insurance companies or individuals to obtain accurate reimbursement;
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Understands the use of and navigation of Medicare’s DDE system and other governmental and commercial payer websites for claim status and corrections;
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Accurately determines Part A and Part B Medicare coverages and billing requirements;
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Reviews correspondence daily for appropriate follow up;
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Able to read and understand explanation of benefit files;
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Works closely with clinical team for accurate charges and modifiers;
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Verifies third party payer coverage;
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Coordinates authorizations when appropriate;
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Works closely with coding team for accurate submission on claim;
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Process and follow up on payer denials, consulting with various entities for completion;
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Understands hospice billing requirements and regulations;
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Research and resolve client billing problems or issues;
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Provide communication on the methods and principles used for billing to the customers and resolve concerns;
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Study contractual terms and conditions of payment to ensure payments are made consistent with terms;
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Conduct work functions to assist with late charge processes;
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Works closely with third party collection vendors for accurate payment records;
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Assist patients and their families with applying for financial assistance;
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Establish payroll deduction transactions;
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Make daily deposits to the bank;
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Ensure change fill requests are complete for department’s daily function;
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Work with patients to develop self-pay arrangements and payment plans when applicable;
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Post payments for both insurance and individuals;
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Review accounts and initiate refunds when applicable;
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Communicate self-pay balances for upcoming services and collect balances due;
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Work with accounting department for accurate financial documentation;
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Edit account for correct coverage documentation;
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Apply contractual adjustments in accordance with contracts;
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Print, scan and index correspondence to the appropriate account;
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Works closely with electronic payment process vendor for accurate posting and adjustments electronically;
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Oversee the electronic flow of the account through the billing process to include bad debt;
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Performs all other duties as assigned
Qualifications
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High school diploma or equivalent
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American Academy of Professional Coders (AAPC) Coding Certification (CPC)
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Working knowledge of computers
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Previous work in a business office, registration or clinical setting
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One (1) year of revenue cycle experience
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Working knowledge of CPT and ICD 10 coding systems
Required Skills/Abilities
- Use of a standard computer keyboard and ten (10)-key calculator
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Effective written, verbal and interpersonal communication skills
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Ability to interact with customers in both hospital and clinic environments.
Day
8:00 am - 4:30 pm
1
Regular
