Payment Application Representative

PAYMENT APPLICATION REPRESENTATIVE

Summary of Essential Duties and Responsibilities: Employee will work as an integral part of the Revenue Cycle team and is responsible for the application of payments to patient accounts, posting of cash transactions, balancing of cash batches and bank deposits in compliance with established policies and procedures. This responsibility includes having a broad knowledge of payor practices and billing guidelines inclusive of electronic and paper insurance claims. This position must follow established industry policies and procedures and adhere to required compliance standards, rules and regulations.

Duties and responsibilities include:

· Posting of remittances from payors to the hospital’s bank accounts, general ledger accounts and patient accounts. This duty includes the posting of both payment and adjustment posting.

· Reconciliation of daily batches and balancing of cash batches and the research and resolution of any issues.

· Application of knowledge relating to explanation of benefits and coordination of benefits to ensure proper reimbursement, allowances and patient payments.

· Thoroughly and promptly researching customer account inquiries as needed for proper resolution.

· Research and escalation of credit balance accounts, including preparation of refunds and escalation for review.

· Resolution of accounts by various methods including, but not limited to, adjustments, transferring funds, corresponding with necessary contacts, responding to inquiries, utilizing various payor tools, initiating recoupment requests; all in accordance with hospital, payor, state and federal guidelines, regulations and procedures.

· Escalates claim issues, payor issues, trends, etc. to proper supervisory personnel for resolution

· Provides constructive feedback to stakeholders on concerns, opportunities, changing policies and procedures, as needed.

· Manages the following worklists and others as assigned: Small Balance and Unapplied Transactions.

· Other duties as assigned.

Supervisory Responsibilities: This position has no supervisory duties. The payment management specialist must be able to make independent decisions regarding work prioritization, coordination, application of department procedures and routine customer service issues.

Qualifications: Strong interpersonal, technical and communication skills. Sound critical thinking, analytical and organization skills, including problem-solving. Self-motivated and self-directed. Ability to work closely with other revenue cycle team members in a collaborative, interactive team environment. Customer service traits that promote a team-oriented attitude for service excellence. Knowledge of medical terminology, surgical and medical processes and procedures and medical abbreviations. Ability to apply basic accounting and math skills to revenue cycle activities. Knowledge of major third-party payors, claim processing guidelines and other standard hospital revenue practices.

Education and/or Experience: Associate degree or certificate in medical billing or insurance coding preferred. High school diploma or general education degree (GED or equivalent) required. At least one -year experience in healthcare patient financial services or related healthcare experience preferred.

“Roane General Hospital is an equal opportunity provider, and employer. “To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD)

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Monday to Friday

Ability to Relocate:

• Spencer, WV 25276: Relocate before starting work (Required)

Work Location: In person