Job Summary:

Responsible for accurate and timely submission of claims and resolution of assigned accounts receivable. Contacts payers or accesses electronic media regarding claim payment and resolution. Answers insurance representative or patient account questions for resolution of claims. Ensures that assigned account inventory does not age beyond acceptable standards in accounts receivable and follow up efforts are effective.

FLSA:

NON-EXEMPT

DUTIES AND RESPONSIBILITIES:

Demonstrates a working knowledge of government and non-government payer regulations and billing requirements and resolves government and non-government claims timely and accurately.

Resolves claims holding for 72/24 hour review, readmission, and is familiar with all government payer requirements including proper billing of MSP claims and medical necessity processes where an ABN is required.

Resolves assigned billed receivables timely so that assigned aged receivables is consistently maintained within best practice standards.

Performs effective follow up activities accurately and timely and documents the appropriate level of detail to maintain a record of all resolution attempts and activities.

Responsible for all denials on a daily basis to maintain minimum write offs.

Responsible for filing appeals.

Meets performance standards as established by department leadership to ensure inventory of assigned work is resolved from the AR timely and accurately. Including high dollar report and any other report as assigned.

Escalates difficult claims to Management when appropriate to ensure timely resolution. Documents all claim hand-offs and follows up to ensure claim was resolved.

Keeps Management informed of government and non-government payer issues and other delays with claims. Assists with quantifying trends so that Management may resolve issues with the payers and/or other departments or issues impacting timely claim submission.

Utilizes all tools available appropriately to maximize resolution of accounts and positively impact cash and AR performance.

Ensures all coverage has been exhausted for accounts under question before assigning remaining balances to patients.

Generates and prints itemized bills and pulls EOB's for patients and insurance companies when requested or to review the accuracy of payments received on a claim when necessary.

Handles all correspondence received from insurance companies and patients as needed, making sure to accurately and effectively resolve claims.

Assists Management with identifying areas of opportunity to improve the government and non-government billing and collections performance.

Keeps up to date and updates Management with all Medicare/Medicaid NCCI, LCD, NCD and MUE edits and updates.

Works assigned schedule to ensure the collection process is not delayed. This includes working with other staff in such a way that the follow-up area is always covered. Any time off must be approved by Management.

Identifies and corrects billing information when applicable; updates patient demographic or financial information as needed.

Prioritize and answers any questions from patients/families concerning account balances in a timely manner established by Management.

Maintains a good working relationship with other departments and staff to ensure correct coding, billing and charge accuracy for accounts in assigned responsibility.

Demonstrates the ability to be flexible, organized, accurate and deal with a variety of people under stressful situations.

Understands you may be required to assist with other team members work load as needed.

Understand what money goal is each month and how much money is needed to meet/reach goal.

Demonstrates the ability to deal with pressure to meet deadlines, to be accurate, and to handle constantly changing situations.

Demonstrates the ability to deal with a variety of people, deal with stressful situations, and handle conflict.

Professional Requirements:

Adheres to dress code.

Completes annual educational requirements.

Maintains regulatory requirements.

Wears identification while on duty.

Maintains confidentiality at all times.

Attends department staff meetings as required within the department.

Reports to work on time and as scheduled; completes work in designated time.

Represents the organization in a positive and professional manner.

Actively participates in performance improvement and continuous quality improvement (CQI) activities.

Coordinates efforts in meeting regulatory compliance, federal, state and local regulations and standards

Communicates and complies with the Benefis Health System Mission, Vision and Values as well as the focus statement of the department.

Complies with Benefis Health System Organization Policies and Procedures.

Complies with Health and Safety Standards and Guidelines.

Education/Experience Requirements:

High School diploma or equivalent required

Two years prior Patient Business Services experience or equivalent of 2 years experience in a healthcare field

Knowledge of CPT/HCPCS along with ICD-9, ICD-10 coding terminology

Knowledge of Medicare and Medicaid billing requirements as well as all Commercial payers

Knowledge of Medicare and Medicaid NCCI, LCD, NCD and MUE edits and all updates.