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Provide billing investigation, follow up related to patient/customer complaints and advocacy for patients related to complaints or billing issues. Ensure proper submission and adjudication on all claims submitted to third party carriers, Medicaid, Medicare. Respond to all inquiries according to PFS policy and procedures.

ESSENTIAL DUTIES AND RESPONSIBILITIES MAY INCLUDE:

1. Advocate for patients regarding complaints or billing issues, while following established policies and procedures, by responding to patient calls/inquiries, reviewing information provided by patient, and asking pertinent follow-up questions to obtain missing information.

2. Provide account resolution, within HFMA Patient Friendly requirement (i.e., 48 hours), by assessing the service provided, reviewing the billing system for errors and/or various 3rd party payers’ contracts for terms that will assist in answering/resolving the patient’s issue. Provide the patient with explanation or address any errors found. Document all activity on patient accounts (i.e., conversations, actions taken, follow-up needed) in the system, according to industry standards.

3. Identify any issues, such as a breakdown in the process that causes delay in payment, or repetitive errors that may be encountered during claim submission and processing and provide feedback to management. Collaborate with manager and PFS staff to resolve these issues in order to improve processes, increase accuracy, create efficiencies, and achieve department goals.

4. Ensure compliance with all state and federal billing regulations by reporting suspected compliance issues to Supervisor/Manager or Compliance Manager.

5. Complete the follow-up of claims when an error is identified according to the PFS guidelines for account follow-up goals. Submit the necessary re-bill for the claim, monitor and expedite by contacting the assigned payor representatives to ensure the re-bill has been received, re-processed, and payment has been made. Keep the patient informed of the steps being taken and the status of the claim.

6. Assist patient in setting up mutually agreeable payment arrangements by explaining the options (i.e., increased future payments, partial lump sum payment with delayed payments for the remaining balance) available to them according to our policy. Refer patient to Financial Assistance/Follow-up Rep to complete the process.

7. Initiate the Financial Assistance process in the event patients communicate financial difficulty in making agreed-to payments, in accordance with Presence’ Health’s Financial Assistance Policy. Explain the process to the patient and why the requested information is necessary, mail the application to them and follow-up with the patient to ensure that they fill out the application completely and within the specified timeframe. Respond to patient’s questions to assist them through the process. Refer patient to Financial Assistance/Follow-up Rep to complete the process.

8. Review payment denials and discrepancies identified through EOB, Remittance Advices or Payor correspondence, research the respective insurance billing regulations and guidelines and, identify and take the appropriate action to correct these accounts. Explain the reason for the payment denial (i.e., not a covered benefit, experimental procedure, etc.) to the patient and provide them with a written description of this exclusion in their policy.

9. Contact various departments throughout Community First Medical Center to obtain additional information such as clarification of coding from HIM, clarification on a procedure, reason for duplicate x-ray, etc., for resolving outstanding issues concerning the billing and follow-up process.

10. Post all payments and adjustments to the appropriate patient accounts in accordance with the current Community First Medical Center policy and procedure.

11. Research all unidentified cash and checks to identify the appropriate patient account, including contacting the source of payment to procure additional information to allow for accurate identification.

12. Provide daily reconciliation sheets to ensure all cash and lock box deposits are reconciled and have been posted to the host patient accounting system.

13. Process electronic remittances and reconcile to the bank deposit to ensure all remittances balance.

Community First Medical Center offers benefits:

· United Healthcare Medical PPO/HMO/HSA Plans, premiums as low as $50.00/full time, $85.00/Part Time

· Met Life Dental and Vision

· Paid Time Off (PTO) with annual accruals up to 168 hrs./year

· Six paid holidays

· Company Paid Life insurance and Short-term Disability

· 401(k) after 90 days

· Sick Bank of up to 40 hrs./year

· Free Parking Garage

· Internal Growth Opportunities

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Knowledge and ability to apply high level of knowledge of respective insurance billing regulations and guidelines.

Able to communicate clearly and professionally and have excellent interpersonal, verbal communication skills

Education and/or Experience

High School diploma or GED

Three years in patient accounting/business office environment, specifically billing and/or collections in the assigned insurance area

PREFERRED: Coding Certification, Two-year higher education or Associates Degree in finance, accounting or business

Community First Medical Center is an affirmative action/equal opportunity employer who is committed to cultivating diversity, equity and inclusion within all aspects of our organizations. We stand against and prohibit discrimination in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status