Job Description

Responsibilities:

1. Insures confidentiality of patient information through HIPAA Compliance.

2. Maintains knowledge base on changes to reimbursement, including but not limited to specific managed care contracts, Medicare/Medicaid guidelines, and third party insurance payers.

3. Initiates appropriately timed correspondence and telephone contact to clarify and explain account or coverage situation with patients or guarantors, employers, insurance companies, and sponsoring agencies; obtains cooperation toward settlement of account.

4. Maintains accountability for the prompt processing of claims including billing, claims transmission, and the collection of those claims, for a set group of accounts assigned.

5. Obtains and follows up on all documentation needed in order to bill.

6. Notifies supervisor and data manager regarding any medical documentation requested by payer sources, or patients.

7. Investigates denials from insurance companies to insure claim resolution.

8. Prioritizes accounts to maximize dollars in collections.

9. Notifies supervisor of problem accounts and/or clinical issues that need to be addressed related to billing and collections.

10. Researches and resolves delinquent accounts to insure timely collections and reduce DSO.

11. Clearly notates databases as specified by supervisor.

12. Submits appropriate documentation for adjustments, write-offs, refunds or bad debt to the appropriate Supervisor, Accounts Receivable.

13. Communicates to supervisor any IT issues.

Qualifications:

- High School Diploma/GED

- 2+ years experience working in hospital access, physician office or billing and collections or an equivalent combination of relevant education and/or experience. A general knowledge related to government payer regulations and third party payer guidelines is helpful.

- Medical collections experience and calling insurance companies, and submitting claims

- Understanding of medical terminology, coding, third party benefits, government payer regulations, collection techniques, and cash management experience, is preferred.

Must be computer literate. Excel experience is a plus.

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