NATURE OF WORK: Responsible for workflow and communication with programs on documentation corrections. Responsible for reports notifying programs and management the status of documentation. Responsible for scanning all paper documentation including downloading & maintaining all paper and electronic remittance and payment source documents/files. Responsible for reviewing remittances and documenting claims issues into program management system and notifying biller of denial or processing error. Assist billers in researching, submission of denied claims for Medicaid, MCO, invoice claims, and occasionally TPL denials. Assists in research to resolve partial payments and unapplied cash on client accounts. Reads and comprehends instructions and informs Revenue Cycle Manager of necessary issues for claim submission and resolution. Possesses the interpersonal skills necessary to interact with consumers and Valley staff, including managers, to resolve any billing questions/issues. Presents and projects a professional, business-like image to consumers and Valley staff.
Ability to batch and apply all cash receipts.
Accurately post payments into database both manually and electronically.
Audits and reviews payments for accuracy and compliance.
Reviews unapplied/unidentified payment issues to assure timely posting to client accounts.
Reviews private pay & completes any refunds – notifies Revenue Cycle Manager of any billing issues.
Responds to customer inquiries and requests that may require extracting and analyzing system data.
Informs appropriate personnel of billing and/or procedural issues.
Establish and maintain constructive working relationships with coworkers, supervisors, managers, as well as external clients and other external business contacts.
Aids in the training of new employees.
Uses the program management system to generate reports and transfer data from system to Microsoft Excel into easily readable format for programs/management and to research as directed.
Assures all request for service corrections are reviewed/completed within business day submitted and communicates status to necessary parties.
Assures the workflow for service correction is followed depending where in the cycle the service is in the billing cycle; unbilled in open accounting period, claimed, paid, or in a closed accounting period.
Confirms census is verified then compiles and post daily room & board charges and saves all generated reports to folder following workflow procedure.
Scans all paper documentation and saves to the correct folder with naming convention procedures.
Maintains and files all paper documentation in the correct file cabinet/folder and attached to the correct paper claim.
Download and maintain all electronic remittance, 835payment, 270/271, 277, and 999 files to the correct folder and naming procedure.
Confirms 835, 270/271, 277, and 999 file is uploaded into Avatar and reviewed for acceptance, rejections, or errors and proceeds to research, correct, or inform responsible staff or department of the error.
Reviews all paper and electronic remittance for denials or communications from guarantor adjudication and records the denial in program management system using the appropriate form(s).
Informs the biller or other responsible department(s) of the denial or partial denial or communications from the guarantor.
Reviews billing/payment activity on consumer accounts for accuracy and makes necessary corrections as directed.
Primary staff to answer phone calls, emails concerning any financial account questions from clients, staff, and/or physicians.
Effectively and professionally resolves issues with clients and insurance payers.
Monitors, maintains, and uses appropriately, all equipment and supplies.
Other duties as assigned.
Ability to perform essential duties as outlined below.
High School diploma or equivalent.
Strong active listening skills.
Intermediate computer skills.
Intermediate knowledge of Microsoft Excel, Word, and Outlook.
Basic knowledge operating normal office equipment.
Ability to comprehend moderately complex instructions.
Ability to multi-task.
Strong attention to detail.
Ability to work in a team.
Demonstrate strong problem-solving abilities.
Ability to comply with Client’s Rights.
Ability to comply with Valley’s and division/departmental safety procedures.
Qualities of reliability, self-motivation, and a positive attitude.
