Responsible for calling and collecting from insurance companies on inpatient and outpatient account receivables. Demonstrates extraordinary commitment to excellence by adhering to departmental excellence criteria.
Major Position Responsibilities:
- Responsible for meeting collection goals that are established by the Director and the Patient Financial Services Manager. Perform timely and effective collection effort through the use of telephone contact, written inquires and or appeals to facilitate appropriate reimbursement of inpatient and outpatient hospital accounts.
- Utilizes QMS to reach daily and weekly goals
- Problem solves and responds to routine provider issues; interpret provider contracts for proper claim payment. Reconciling account balances, corrects any errors, including misapplied payments, late charges, interest payments or over payments from the insurance carriers
- Reviews accounts for contractual adjustments based on contract loaded in Alliance/AVEGA. Immediately reports discrepancies to management and may assist with “special projects” as assigned.
- Refers any account requiring further action to the appropriate follow up representative or agency.
- Use judgment in escalating unresolved issues to management. Coordinate and clearly communicate issues to responsible parties.
- Continue to stay informed of any changes in regulations, statutes, or contract changes that could impact collection of receivables.
- Complete daily and weekly volume/productivity management reporting.
- Researches, identifies, and rectifies any special circumstances affecting delayed payment of accounts, when appropriate
- Takes personal initiative to bring forward process/performance improvements as identified. Performs special assigned duties to meet the needs of the department.
- Workstations, desk and surrounding area to be kept neat, clean and safe for other employee’s to work at any time.
The above statement reflects the general duties considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all the work requirements that may be inherent in the position.
Safety and Infection Control Responsibilities:
Responsible to maintain a safe and clean work environment, including unit based specific safety and infection control requirements.
- Requires at least three years of medical insurance billing and collections in patient accounting business office or hospital setting. Experience with the collection and billing of HMO, PPO, Workers Compensation, Indemnity, Medicare and Medi-Cal and other types of insurance for claims reimbursement.
- Expected production calls up to 40 accounts per day. Medical Terminology, ICD-9, CPT and HCPC coding essential is necessary. Interpretation of health plan contracts as it relates to reimbursement is a must and how to calculate rates from coding to contract. Experience with collector work list and the responsibility of keeping a daily or weekly tab on patient accounts.
- Persuasive negotiator to be used when calling health plans for payment. Must have strong interpersonal, verbal and written English language skills sufficient to interact effectively with both internal and external contacts.
- Triaging of accounts before following up with the insurance carrier to determine what is necessary to get the claim paid. Must be able to work with other professionals and license personnel to resolve issues and make certain decision with the scope of the position.
- Must have experience in a Windows environment, able to create a spreadsheet, letters and documents using Microsoft Office to include Microsoft Word and Excel.
- Must know how to use the Internet as it relates to the follow up of insurance payments on the health plans websites. Must know how to use Microsoft Outlook for internal and/or must have the ability to read, understand and interpret correspondence from a health insurance plan.
- Requires typing skills of 45WPM. Excellent human relations’ skills including listening, conflict resolution, coaching, and team building.
- Must have ability to demonstrate flexibility in response to unexpected change in work volume and hospital staffing needs. Process oriented skills with ability to handle multiple projects simultaneously by prioritizing responsibilities and meeting deadlines required. Ability to ensure the confidentiality and rights of patients and the confidentiality of hospital and departmental documents required.
Physical and Environmental Demands:
Requires prolonged sitting, some bending, stooping and stretching. Requires eye-hand coordination and manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator, and other office equipment. Requires normal range of hearing and eyesight to record, prepare and communicate appropriate reports. Requires lifting papers or boxes up to 50 pounds occasionally. Work is performed in an office environment. Work may be stressful at times. Contact may involve dealing with angry or upset people. Staff must remain flexible and available to provide staffing assistance for any/all disaster or emergency situations.
- High school diploma or GED required.
- Medical insurance billing experience preferred.