2 years experience required! Ensures accurate preparation and submission of insurance claims. Responsible for following claims for payment and maintaining low accounts receivable.
Key Tasks & Responsibilities
- Maintains database for Insurance denials and appeals.
- Determines patient financial responsibility and arranges suitable payment arrangements with patient; and Patient Service Manager.
- Ensures accurate posting of insurance payments, and adjustments from Remittance Advice in a timely manner.
- Posts write-offs, account adjustments and corrections daily to the patient accounts. Enters and reconciles all charges and credits to patient accounts.
- Files electronic and/ or paper insurance claims daily.
- Reviews each Explanation of Benefits received with payments to verify determination of payment to facility has been reimbursed correctly, and begins appeal process as necessary.
- Reviews status of assigned accounts for unpaid claims and follows up appropriately with insurance company or patient.
- Assists Patient Service Manager with any assigned daily, monthly and yearly reports.
- Handles phone calls from assigned accounts regarding account balances or insurance filings.
- Cross- trains to proficiency in Admissions, Reception and HIM areas, and fills in as needed in these areas for breaks, illness and vacation.
- Documents concisely, precisely and accurately on records or documents as indicated by this policy.
- Communicates effectively and works cooperatively and professionally with all co-workers, management, patients, visitors, physicians and others.
- Demonstrates work as a team player.
- Participates in Quality Assessment activities as directed for the continuous improvement of patient care and hospital business.
- Performs other duties as assigned.
- Actively supports and upholds the mission and core values of the Hospital.
- Remains knowledgeable of and follows the policies of the Hospital.
- Maintains patient and hospital confidentiality at all times.
- Keeps Manager apprised of day to day situations.
Environmental & Physical Requirements
Candidate must be able to read and speak English fluently, have cognitive skills for math, reading computer skills, communication skills to deal well with the public as well as peers. Vision for near, mid-range, far and accommodation. Hearing for low, medium and high pitch sounds. Minimal up and down activity may be possible. Job risks include: Exposure to computer for 6-7 hours per day with typing activities, lifting of 20-30 pounds maximum.
High School diploma or equivalent required. Two years previous experience with accounts receivable, billing and insurance required. Computer skills, basic office skills, knowledge of medical terminology required.