Patient Account Rep - Billing & Collections Specialist

Description

Oneida Health is currently seeking a full-time Patient Account Representative - Billing Specialist to work days in our corporate offices. The Patient Account Representative – Billing & Collections Specialist performs daily activities related to the submission of governmental and third party payer health care services bills, accurately and timely, to support departmental goals and objectives relative to a clean claim submission rate of 85% or greater in accordance with established key performance indicators (KPI’s). Responsibilities revolve around ensuring accurate and timely billing for assigned service line, analyzing patient accounts, identifying overpayments, processing refunds, and managing credit balances in accordance with established policies and regulations. This position is responsible for supporting and contributing to the team efforts in the achievement of pre-established accounts receivable performance goals.

• Net and Gross Days outstanding in Accounts Receivable
• Percent of Accounts receivable aged greater than 90 days
• Cash collections
• Credit Balances as a Percent to outstanding receivables
• Denials resolution
  
  

POSITION SPECIFIC PERFORMANCE STANDARDS

• Assists supervisor in training and education for new staff hires.
• Monitors payer updates and bulletins and shares with coworkers, supervisors, director and business analyst as appropriate.
• Works collaboratively and cohesively with the team to assist in keeping workload evenly distributed
• Reviews assigned claims daily for accuracy
• Performs required edit corrections as applicable and submits claims and rebills to payers in manual and/or electronic format to ensure accurate and timely filing of claims and prompt payment.
• Reports all recurring rejected claims to management for evaluation of impact on the timely filing of claims.
• Exercises independent judgment to analyze and report repetitive edit failures so that corrective actions can be taken.
• Identifies ways to improve billing processes and makes recommendations to Billing and Claims Management Supervisor. Implements and monitors results as appropriate in support of the overall goals of the department.
• Monitors assigned bill holds and work lists at all sources and insures expeditious resolution. Works with other departmental representatives in resolve. Reports unresolved issues and concerns impeding the billing process and to ensure that filing deadlines are not exceeded.
• Assists, as needed, with required actions in order to resolve the account balance promptly by submitting appeals, correcting account information, coordinating requests for medical records, requesting posting of account adjustments, requesting an account re bill and any and all other actions necessary to secure account payment. Documents and tracks turnaround time of receipt of any outstanding documents required from external departments.
• Informs the supervisor of any problems or changes in payer requirements and exercises independent judgment to analyze and report repetitive denials so that corrective actions can be taken.
• Achieves established productivity standard as determined by the Billing and Claims Management Supervisor. Tracks productivity and provides cumulative reports on a daily, weekly or monthly basis, as required by supervisor.
• Documents all actions taken on accounts in the system account notes to ensure all prior actions are noted and understandable by others.
• Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact patient account collections. Adheres to internal controls for applicable state/federal laws, and the program requirements of accreditation agencies and federal, state and private health plans.
• Seeks advice and guidance as necessary to ensure proper understanding.
• Effectively utilizes payer websites as needed in the execution of daily tasks.
• Complies with patient confidentiality policies for the retention of patient health information, or when handling, distributing, or disposing of patient health information.
• Performs other duties as assigned by the Supervisor.
• Handles telephone information with courtesy, accuracy, and respect for confidentiality; receives information and distributes messages appropriately.
• Consistently communicates appropriately with patients and staff and responds to requests for assistance promptly.
• Provides accurate communication in verbal, nonverbal and written form. Listens effectively.
• Communicates effectively with supervisor and team members, including but not limited to changes of operation. Reports to supervisor regularly on the status of ongoing projects.
• Follows proper chain of command appropriately to resolve problems and concerns.
• Treats patients and their families with respect and dignity, and ensures confidentiality of patient records.
• Provides positive and productive support to the team and promotes teamwork. Is kind, courteous, respectful and professional in all interactions with all hospital personnel at all levels
• Perform Account Status and Follow-up
• Resolve credit balances
• Respond to and resolve claim payment denials
• Correspondence resolution
• External audit requests related to credit balances
  
  

Qualifications

QUALIFICATIONS:

• Education:
• High School diploma. Degree or additional applicable education and/or certificates highly preferred.
• Experience:
• Five years’ experience directly related to health care inpatient and outpatient billing.
• In depth knowledge and familiarity with healthcare medical terminology, billing and coding
• Intermediate knowledge base of the reimbursement guidelines for all major third party and governmental payers; Medicaid, Medicare, HMO’s; Commercial, Worker’s Compensation and Third Party Liability.
• Good communication, technical and interpersonal skills.
• Proficiency in use of PC and Microsoft Office Suite use and application and use of internet.
• Proficient knowledge base of patient accounting systems.
• Understands and complies with HIPAA and Protected Health Information rules and regulations.