This position is accountable for accurately analyzing and collecting balances on patient accounts, to include duties related to charges, filing, and follow up of third party insurance claims and correspondence in a timely and appropriate manner insuring that all policies, regulations and procedures are followed.
Talent Pool: Corporate Services/Professional
Acts as a liaison between Cones Health and multiple third party payers. Initiate contact with third parties to identify and subsequently resolve obstacles affecting payment. Review third party remittance advices to assure compliance with expected reimbursements and to initiate further action as needed to facilitate full reimbursement. Pursues unsettled insurance accounts in the method and manner prescribed by policy, (so that no more than 10-15 claims go beyond the 60 day standard per year without appropriate resolution or action taken.)
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Analyze account balances to ensure accuracy of account for appropriate adjustments according to federal/state laws and hospital preferred provider contracts and in a timely manner; (with no more than 3-5 noted errors per year.)
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Responds to requests to ensure reimbursement is obtained. Respond to third parties• requests for further information by coordinating with other Hospital departments such as Medical Records. Promptly responds to all telephone calls regarding patient accounts for review and analysis. Properly evaluates priorities and organizes time accordingly so that required activities are completed on a timely basis.
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Maintain current working knowledge of changes in health care reimbursements. Attends seminars and weekly staff meetings. Follows all Corporate Compliance Rules and Regulations. Follows all HIPAA regulations without exception.
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Ensures thorough, concise, and up-to-date documentation is maintained in accordance with procedure, so that collection efforts, responses to inquiries, and patient account status can be researched and verified, as necessary by all reps for customer service to utilize to assure accurate response in patient inquiry resolutions.
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Maintain acceptable level of quality and production standards as determined by supervisory review and audit of assigned account categories. Notifies manager of possible or potential issues that may result in delays in payments or increase of denials.
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Talent Pool: Corporate Services/Professional
EDUCATION: High School Diploma or equivalent, Required
Associates, Preferred
High School Diploma or its equivalency required; Associate Degree preferred.
EXPERIENCE: 3-5, Required
4-5, Preferred
Minimum of 3-5 years reimbursement experience in hospital, clinic or medical business office to include Government payers' required; 4-5 years experience preferred.
LICENSURE/CERTIFICATION/REGISTRY/LISTING: REQUIRED
N/A
PREFERRED
N/A
