Kaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our eight-campus healthcare district has 613 beds and offers comprehensive health services across a broad continuum of care.
It takes a special person to work for Kaweah Health. We serve a region where the needs are great, which makes the rewards even greater. Every day, we care for people facing unique challenges and in need of healing. Throughout it all, our focus is to make a difference, and we do — in the health of our patients, our loved ones, and our community.
Benefits Eligible
Full-Time Benefit Eligible
Work Shift
Day - 8 Hour or less Shift (United States of America)
Department
8530 Patient Financial Services
Maintains complete and full knowledge of payer(s) assigned to ensure accurate billing and collection of the claims. Validates that the Kaweah Health is being reimbursed by the payer in accordance with government or contract terms.
QUALIFICATIONS
Education
Preferred: High school diploma or equivalent
Experience
Required: Prior Patient Accounting or admissions experience. Comparable medical billing education may be considered.
JOB RESPONSIBILITIES
Essential
Maintains complete and full knowledge of payer(s) assigned to ensure compliance of specific guidelines and rules, as well as ensuring the Kaweah Health is being reimbursed by the payer in accordance with governmental or contract terms. Is a resource to Finance division management regarding the assigned payer.
Brings any reimbursement or compliance concerns to the attention of the Patient Accounting Manager.
Utilizes computer systems and/or billing reports to review all patient registrations or admissions for demographic information, appropriate financial class, insurance company and plan, and charges. 100% accuracy of this information is required to ensure proper recording of revenue, necessary authorizations are obtained, payer classification, correct billing of patient account, and other statistical indicators. Brings any unresolved issues to the attention of their manager.
Audits unbilled reports for potential holdups of patient accounts. Works closely with Medical Records on coding issues, Insurance Verification Clerk on insurance issues and other departments as necessary.
Completes billing process. Ensures all charges are accurate and appropriate. Payer guidelines will be followed during the billing process. After billing has been completed, uses appropriate charge description master (CDM) number to identify the payer and when the account was billed. Works closely with departments on unresolved issues.
Reviews and researches patient account credits and refunds as appropriate to patient and/or payer. For governmental payers, has the credit retracted.
Receives all correspondence and inquiries related to patient accounts and payer contract for which they are responsible. Answers mail and take appropriate action within specified timeframe.
Bills any secondary payers, change financial classes accordingly and sends appropriate collection system letter to patient for co-pays and deductibles owed, denied services, amounts applied to deductible, etc. Uses correct CDM code to identify what secondary payer was billed and when.
Reviews and works aging reports to identify unpaid patient accounts. Follows up with payers for timely reimbursement.
Works to ensure that days in accounts receivable goals are met maintained and/or lowered. Maintains job productivity and quality standards on a consistent basis as established by division management.
Answers phones as a back up to other departmental staff. Takes messages or routes calls as appropriate. As back up, assists customers at the service counter.
Conforms with patient confidentiality standards.
Demonstrates the knowledge and skills necessary to provide care and services appropriate to the population served on the assigned unit or work area.
Performs other duties as assigned.
Addendum (essential for specific dept)
Insurance or managed care payer:
Has complete knowledge of assigned insurance payer, knows contract terms, requirements and payment practices.
Receives prior day's explanation of benefits or remittance advices for assigned payer(s). Reviews to ensure that appropriate contractual adjustments have been taken by payer. Works closely with payer to resolve issues and brings continued problems to the attention of their manager.
Monitors patient accounts for secondary payer reimbursement.
Medicare payer:
Gets electronic remittance advice (R/A) ready for the Accounts Receivable Clerks. Distributes Medicare mail.
Reviews DRG worksheet for accuracy of reimbursement. Reviews all denied changes for appropriateness.
Reviews the Pending Billing List report and deletes non-covered services. Checks for overlapping claims through accounts receivable inquiry (ARI).
Reviews and processes recurring accounts according to procedure.
If responsible for professional billing, processes these bills according to procedure.
Reviews and follow up on the DDE system.
Medi-Cal payer:
Maintains full and complete knowledge of the regulations governing the Medi-Cal payer.
Reviews the Pending Billing List report and/or the Final Accounts and Cycle Billed report. Follow up is completed according to procedure.
Reviews and processes R/A's following procedure.
Reviews MEDTRIEVE data to identify problems in billing. Reviews statistical data with their Manager to maximize reimbursement
Reviews Medi-Cal TAR Dashboard weekly for any follow up on approved or denied TARs.
Self-pay accounts:
Responsible for the administration of the Computer Collection letter service interface (CCI) process.
Prepares and completes the bad debt write-off and assignment to the collection agency.
Acts as a liaison to the collection agency and works with patients regarding hospital accounts assigned.
Responsible to identify patient accounts that may qualify for charity care. Works with patients who inquire about charity program.
Monitors patient accounts pending the Medi-Cal disability process and/or TCMS program.
Responsible for the estate lien filing in the case of deceased patients to assure that the Kaweah Health receives payment on accounts.
Lead also responsible for:
May be responsible for educating individuals in the Patient Accounting Department on new processes and/or payment regulations.
May be assigned to develop training curriculum on new processes.
Provides department staff with information regarding updates or changes.
May serve as a Subject Matter Expert (SME) for systems issues and claim payment issues.
Identifies, investigates, and appropriately communicates account errors in order to prevent further errors.
Proactively and critically analyzes departmental processes and products, makes continuous improvements.
Keeps the Director of Patient Financial Services informed of any potential issues or areas of concern on an ongoing basis.
Pay Range
$23.37 -$35.05
If you want to use your talents alongside people who face each day with courage and purpose, in an environment that empowers you to do your absolute best, this is where you belong.
