- Acts as a patient advocate to obtain additional information and support for claims processing or to discuss outstanding patient balance with options available for balance resolution
- Assist with special projects related to payer issues or overall collections shortfalls
- Categorize and quantify payer payment issues for resolution and reporting to management
- Demonstrate and maintain consistent customer focus in the face of adversity and change both internal and external
- Demonstrate the ability to contact insurances in a consistent and knowledgeable manner in order to obtain timely payments, this includes escalation of issue to supervisors
- Demonstrates understanding of payer fee schedules, enrollment requirements along with PHI payer and facility contracts
- Demonstrates, performs an understanding of insurance collections to include; payment in full (negotiation) offers, overpayment reviews and approvals, next action on correspondence, insurance types, insurance classes, in compliance with PHI's billing policies and procedures
- Draft correspondence to patients and payers including 1st level appeals for technical denials, and identify accounts to refer to Appeals Department for escalation
- Handle patient calls in support of collections activities to include financial review for charity program, payment plans, negotiation of discounts and proper resolution of patient complaints
- Maintaining a professional relationship and effectively communicating with first responders, facilities, PHI agencies, entities, insurers, attorneys and patient's
- Must demonstrate positive teaming, effective cooperation in all communication within established team and throughout the entire PFS department
- Organize and prioritize work to support production goals utilizing on-line tools and required systems and software
- Participate in increasing responsibility through ongoing training and expansion of duties
- Perform financial screening for payment in full (negotiation) offers, setting up payment plans and PHI's charity program in compliance with PHI's billing policies and procedures for appropriate next required action
- Perform in-depth account review such as; skip tracing, correspondence research, secondary claims billing, payment review, contractual adjustments and modify insurances/demographic information in compliance with PHI's billing policies and procedures for appropriate next required action
- Perform, identify, collect and confirm insurance coverage to include obtaining prior authorization, third party liability and coordinator of benefits
- Possess a good working knowledge of HCPCS, CPT, ICD-9, ICD10 codes, medical terminology and clinical documentation
- Review and evaluate any patient account for appropriate handling – regardless of age, status or payer
- Review and interpret explanation of benefits to determine contractual compliance, accuracy of payment received, true patient responsibility, status of denied or reduction of service coverage and follow up appropriately
- Understand billing requirements for all payers and participate in ensuring claims are accurate prior to submission; train staff on billing requirements for new and established payers
- Understand insurance regulations and guidelines to include CMS guidelines in order to effectively discuss outstanding claims with payers related to slow payments, underpayments, denials and to ensure claims are processed compliantly and paid appropriately
- Complying with Company HS&E policy and procedures
- Responsible for supporting company Safety Management Systems activities
- Understand and provide visible support of Destination Zero
- Other duties and responsibilities as assigned
- 5 & 2
- Phoenix, AZ
- High school diploma or GED equivalent.
- Have 3 to 5 years of previous experience in medical billing/collections in a medical office, clinical site, or billing/collections office.
- Knowledge of general office procedures and using office equipment.
- Have PC skills and knowledge of Microsoft Office Word and Excel.
- Must have prior experience with email and using the web.
- Must be able to pass a pre-placement drug test and background screen
- Regular pay scale applies
- Safe. We are absolute in our belief in the tenets of Destination Zero and that Zero is not only achievable, but the only acceptable outcome.
- Efficient. We are focused on outcomes that are smart and responsible by making the best use of our resources to maximize overall productivity and achieve sustainable profitability as a high performing organization.
- Quality. We are committed to ensuring excellent organizational performance which produces sustainable and reliable outcomes.
- Service. We are dedicated to the service of our customers, our communities and each other.
- Drive & Energy – The ability to maintain a fast pace and continue to produce during exhausting circumstances.
- Functional & Technical Expertise – Allows the individual to add organizational value through unique expertise and serve as a resource to the organization within his/her area of expertise
- High Standards – Sets the stage for continuous improvements, the adoption of best practices and ultimately influences organizational standards.
- Initiative – Takes a proactive approach and takes action without being prompted.
- Integrity – Acts ethically and honestly and applies those standards of behavior to daily work activities.