Mamc Jobs (NOW HIRING)

Inspire health. Serve with compassion. Be the difference.

Job Summary

Essential Functions

• All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health. Serve with compassion. Be the difference.

• Assists in the processing of insurance claims including Medicaid/Medicare claims.

• Collects and enters patient's insurance information into database.

• Assists patients in completing all necessary forms. Answers patient questions and concerns.

• Reviews and verifies insurance claims. Requests refunds when appropriate.

• Processes Medicare correspondence, signature, and insurance forms.

• Follows-up with insurance companies and ensures claims are paid within timeframes as outlined in MA policies and procedures.

• Resubmits insurance claims that have received no response.

• Answers telephone, screens call, takes messages, and provides information.

• Maintains files with referral slips, Medicare authorizations, and insurance slips.

• Identifies delinquent accounts, aging period and payment sources. Processes delinquent unpaid accounts by contacting patients and third party reimbursors.

• Reviews each account, credit reports and other information sources such as credit bureaus via computer.

• Performs various collection actions including contacting patients by phone and resubmitting claims to third party reimbursors.

• Evaluates patient financial status and establishes budget payment plans. Follows and reports status of delinquent accounts.

• Reviews accounts for possible assignment makes recommendation to Credit Manager and prepares information for collection agency.

• Assigns uncollectible accounts to collection agency or attorney via clinic Credit and Collection policy. Contacts lawyers involved in third-party litigation.

• Answers inquiries and correspondence from patients and insurance companies. Develops collection letters.

• Identifies and resolves patient billing complaints. Research credit balances.

• Oversees claim processing and payments to third party providers. Answers associated correspondence.

• Monitors charges and verifies correct payment of claims and capitation deductions.

• Sends denial letters on claims and follow-up on requests for information.

• Audits and reviews claim payments reports for accuracy and compliance.

• Research and resolves claim and capitation problems.

• Maintains timely provider information in physician files.

• Maintains insurance company manual and distributes information to staff on updates and changes.

• Maintains required databases and patients accounts, reports and files.

• Resolves misdirected payments and returns incorrect payments to sender.

• Answers patients' inquiries regarding account balances.

• Appeals denied claims adhering to payer policy while communicating with MAMC department for further assistance with claims resolution as appropriate.

• Works all assigned claims within designated time frame to ensure timely and appropriate payment

• Research all information needed to complete billing process including getting charge information from physicians.

• Works with other staff to follow-up on accounts until zero balance or turned over for collection.

• Assists with coding and error resolution.

• Maintains required billing records, reports, and files.

• Investigates billing problems and formulates solutions. Verifies and maintains adjustment records.

• Maintains and enhances current knowledge of assigned payers with regard to guidelines for billing

• Provides training to front office staff when hired and retraining as needed or requested with regard to a specific payer rules and guidelines for physician billing.

• Recommends changes to departmental processes as necessary to maximize operational effectiveness of the revenue cycle.

• Maintains strictest confidentiality.

• Participates in educational activities.

• As representative of Prisma Health Clinical Department, is expected to maintain neat and professional appearance, demonstrate commitment to serve at all times and uphold guidelines set forth in office manual.

• Performs other duties as assigned.

Supervisory/Management Responsibility

• This is a non-management job that will report to a supervisor, manager, director, or executive.

Minimum Requirements

• Education - High School diploma or equivalent OR post-high school diploma / highest degree earned. Associate degree in a technical specialty program of 18 months minimum in lengthpreferred

• Experience - Two (2) years in billing, bookkeeping, collections or customer service.

In Lieu Of

• NA

Required Certifications, Registrations, Licenses

• NA

Knowledge, Skills and Abilities

• Electronic Claims Billing experience

• Multi-specialty group practice setting experience preferred

• Intermediate ICD-9 and CPT coding abilities preferred

Work Shift

Location

Facility

Department

Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.