Works under the direct supervision of the Patient Financial Services Manager with ultimate supervision by the Director of Revenue Cycle. Oversees regarding reimbursement of unpaid accounts over 30 days old, researching and following up on denials and requests for additional information. Works with staff and management for resolution of problematic and aging accounts. Works with management on workflows to improve AR goals and timelines for working aging claims. Monitors denials for aging trending and provides oversight regarding education to staff to improve knowledge so that accounts are worked properly. Captures key performance indicators and other suggestions for improvement and decision support. Works closely with stakeholders from different functional units on topics, including billing and edit/denial management. Attends educational in-services as appropriate. Prepares detailed reports as needed to assist leaders in cash and AR reporting. Identifies, analyzes, and monitors issues that affect AR, contractual allowances and adjustments. Performs research, audit, and analysis of payer and business data to help identify and understand variances and fluctuations in reimbursement. Maintains a thorough understanding of patient billing systems. Keeps current on third party regulatory changes; helps monitor Medicare/Medicaid and third-party settlements. Develops and provides staff education to include topics on understanding edits, payer specific billing nuances, governmental payer nuances, and upcoming changes to billing rules, etc., to improve breadth of knowledge with in the biller pool.
PRIMARY JOB DUTIES
Performs follow up on accounts that have not been initially adjudicated by the payer utilizing assigned work queues and prioritization standards.
Reports any reimbursement trends/delays to management (E.g., billing, denials, claim denials, pricing errors, payments, etc.)
Follows up on open receivables after appeal has been submitted.
Utilizes payer technology and resources to support account resolution activities.
Prepares daily, weekly, monthly, quarterly, and other reports as needed.
Assists management in generating reports
Develops and provides staff education on topics to improve biller performance.
Frequently interacts with other finance staff, Information Technology staff, Patient Financial Services Department, Health Information Management Department, Patient Access Department,
Performs related duties as assigned
Utilizes current payer contract terms and payer mix information to estimate net revenue calculations.
Monitors billing changes that may affect revenue and assesses contract terms and methodologies to ensure maximum reimbursement
Maintains confidentiality of all personnel and patient care and relations information.
Actively participates in Strategic Plans for the department and organization. Actively participates in Customer/Guest Relations and Mandatory Education programs.
Follows hospital and departmental policies and procedures.
Must be free from governmental sanctions involving health care and/or financial practices.
Complies with the hospital’s Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations.
Education: High school graduate.
Certifications required: See Cardiopulmonary Resuscitation Certification Policy and Certifications/Education Requirements Policy
Experience: Organizational Astuteness, Managing Processes, Process Improvement, Reporting Skills, Change Management, Coaching, Client Relationships, Supports Innovation, Developing Standards, Hiring, Administrative Writing Skills.
Essential Technical/Motor Skills: Computer skills. Computer literate with good keyboarding skills. Typing 40 WPM. Eye-hand coordination, manual and finger dexterity. Ability to run a copier. Ability to answer phones. Ability to learn and utilize alphabetical and terminal digit filing systems.
Interpersonal Skills: Excellent interaction with visitors, patients, coworkers, medical staff, outside agencies effectively and courteously. Corresponds effectively with outside agencies.
Essential Physical Requirements: Ability to bend, lift, pull, sit, and stand for prolonged periods of time. Ability to work in small spaces.
Essential Mental Abilities: Attention to detail. Reasoning. Review of requests for appropriate criteria. Ability to interpret and apply federal and state statutes regarding the disclosure of healthcare information.
Essential Sensory Requirements: Sufficient vision, hearing, and speech to perform duties.
Exposure to Hazards: OSHA CATEGORY III. Identified job duties do not have any anticipation for contact with blood, contaminated body fluids or tissues. Employees working in healthcare facilities have the potential to be exposed to hazardous materials including: Hazardous Chemicals/Drugs, Waste Anesthetic Gases, Radiation, Latex, Biological Hazards, Respiratory Hazards and Ergonomic Hazards. See Hazardous Materials in the Workplace Policy.
Hours of Operation: 7:00-5:30 Monday-Friday
Regularly attends staff meetings.
Completes mandatory education.
Employment Type (feed only)