Nuvance Health is a family of award-winning nonprofit hospitals and healthcare professionals in the Hudson Valley and western Connecticut. Nuvance Health combines highly skilled physicians, state-of-the-art facilities and technology, and compassionate caregivers dedicated to providing quality care across a variety of clinical areas, including Cardiovascular, Neurosciences, Oncology, Orthopedics, and Primary Care.
Nuvance Health has a network of convenient hospital and outpatient locations — Danbury Hospital, New Milford Hospital, Norwalk Hospital and Sharon Hospital in Connecticut, and Northern Dutchess Hospital, Putnam Hospital Center and Vassar Brothers Medical Center in New York — plus multiple primary and specialty care physician practices locations, including The Heart Center, a leading provider of cardiology care, and two urgent care offices. Non-acute care is offered through various affiliates, including the Thompson House for rehabilitation and skilled nursing services, and the Home Care organizations. For more information about Nuvance Health, visit www.nuvancehealth.org.
HQMP Billing and Collections Coordinator
HQMP AR Supervisor of Billing & Collections
These positions is responsible for a variety of duties including billing, collections, follow up, and appeals process to support the HQMP Business Office in delivering the highest level of service. The team performs all job related duties as assigned.
RESPONSIBILITIES AND STANDARDS
Responsibility I and II
HQMP entities, including but not limited to:
- Assumes responsibility for the timely, accurate and compliant BILLING activities for
- Review and edit demographic information and other Pre-Billing functions
- Process claims through electronic system correcting all errors prior to submission
- Validate claims sent are received by Payer
- Maintains up to date knowledge of all regulatory edits and payor specific edits and how to resolve each to ensure claims are submitted timely
- Contacts patients directly to obtain missing financial information needed to process claims timely
- Enters all transactional comments into the system to assure accurate account documentation
- Meets performance goals as defined by senior management (ex: clean claim rate, etc)
- Meets productivity and quality metrics daily/weekly.
- Maintains current knowledge of hospitals’ billing systems (eCW, TriZetto, other)
- Maintains current knowledge of billing forms and filing requirements
- Maintains a current knowledge of various payer contracts
- Maintains current knowledge of Federal, State and managed care billing methodologies, rules and regulations.
Responsible for the FOLLOW-UP AND COLLECTION activities of HQMP entities, including but not limited to:
- Works accounts according to the priority determined by electronic work list
- Corresponds with third party payers, physician offices and/or patients to obtain information. Escalates problems and high dollar accounts to the Supervisor for guidance and support
- Develop comprehensive and effective appeal letters to overturn the denials
- Coordinates with various physician offices to effectively appeal denials in a timely fashion by obtaining clinical information to be included in appeal letters
- Understands clinical policies for each commercial payor in order to effectively write appeal letters
- Communicates with the Managed Care Dept on all payor issues related to contract interpretation and compliance
- Meets performance goals as defined by senior management
- Meet daily and weekly productivity and quality goals
- Informs Supervisors/Managers of key issues on a timely basis communicating key observations, issues and trends
- Enters all transactional comments into the system to assure accurate account documentation.
- Maintains current knowledge of effective follow-up and collection approaches
- Maintains current knowledge of timely payment regulations and holds payers accountable. Escalates non-compliance to senior management
- Maintains current knowledge of hospitals’ patient accounting systems (and other related tools)
Responsible to serve as the first point of contact to address questions & concerns of staff members to provide coaching, feedback, direction, and guidance and to escalate operational concerns or developmental needs to supervisory staff.
- Monitors the billing, collections, credits activity to ensure complex issues are escalated/resolved
- Leads all payor meetings and coordinates the agenda, action items, and resolution related to all payor issues
- Coordinates all Collaboration meetings and ensures all staff members are prepared to discuss issues related to their payors
- Identifies training needs within the their respective teams and communicates these needs to the HQMP Educators
- Assists the HQMP Educators with providing training in a specific areas when needed
- Performs quality audits and reviews the results with their staff
- Interacts with external customers such as payers, vendors and related transactional groups in order to accomplish tasks
- Accountable for the achievement of key strategic goals
- Responsible for continuous improvement activities by developing and implementing efficiencies within the department that will add value to the process
- Participates in the training of new hires in the functions of the department
- Determine education needs of the department and communicate to supervisor
- Assists supervisor with workflow distribution
- Drafts comprehensive appeals, faxes and letters to payers and patients providing additional or requested information that will resolve account issues.
- Follows all Health Quest Policy and Procedures and sets an example for staff
- Produces productivity and quality reporting for management review weekly.
- Reviews and approves refunds based on departmental protocols
Responsible for improvement planning and development of their team’s effectiveness
- Recommends focused training needs and/or new educational topics.
- Ensures staff has the most up-to-date resources and knowledge of new technology to effectively and efficiently handle all functions of billing and follow up
- Researches and recommends new resources for accurate billing and follow up functions.
Requires a High School Diploma or GED, CPC License preferred
A minimum of three years in patient accounting required.
Medical Terminology, Knowledge of ICD-9 and CPT-4 codes, excellent verbal and written communication skills, attention to detail, general math skills, documentation skills and knowledge of procedures and revenue cycle flow in a healthcare organization.
PHYSICAL AND MENTAL FACTORS
Occasionally requires light physical effort as in periods of standing at files or work tables, repeated changes of position within the work routine or prolonged sitting.
ENVIRONMENTAL AND WORKING CONDITIONS
Some minor physical inconveniences or discomfort routinely present in the work situation.