System Coordinator Patient Accounts - Collection Specialist

POSITION SUMMARY:

The System Coordinator, Patient Accounts I, serves as a gatekeeper for the Nexus Health Systems Business Office. This position handles Central Business Office incoming telephone calls, correspondence, payment posting, and daily bank reconciliations. This position confirms the patient account has the correct payment applied per the EOBs, remittance advice, self-pay receipts, and balance to the bank deposits. Prepares monthly Self Pay Letters for each facility; Letters 1, 2, and 3 for self-pay identified accounts. Prepares accounts for external collections on self-pay accounts aged 120 + that have received three collection letters.

JOB-SPECIFIC RESPONSIBILITIES:

1. Responds to telephone calls, working with those that are routine in nature, or routing the appropriate staff member as calls occur.

2. Pulls daily Remittance Advice from banks.

3. Log on to payer sites to pull EOB’s not provided online at the bank.

4. Contact customer service at banks to assist in identifying missing remittance advice to post payments.

5. Post payments received from remittance advice pulled from the banks.

6. Confirm payments are posted to the appropriate interims as identified on the EOBs.

7. Run payment logs and confirm payments posted balance to the daily deposit on the cash log.

8. Research discrepancies and reconcile daily. Confirm payments in the “Needs Dispersed” column on the payment log are addressed daily and/or before the end of the month.

9. Create Self-pay buckets with balances to post “no show” payments received.

10. Assist with posting approved patient account adjustments.

11. Unidentified payments need to be posted to Suspense. If the deposit does not identify a patient to post on the remittance advice, keep a log of the deposit date, amount, payer to monitor the mail for the paper EOB to arrive. If unable to identify patient to post the payment before month-end close, post to Suspense.

12. Keep a Suspense log and folder of EOBs unable to post to a patient account. Organize the log by facility by date of unapplied EOBs. Forward a copy of the Suspense log and outstanding EOBs to the CFO the day following close.

13. When EOBs are received to apply the payment for those posted to Suspense from a prior month, remove the suspense payment and post to the patient account. Identify the payment on the Suspense Log and provide the supporting documentation at the end of the next month to the CFO to continue reconciling the suspense file.

14. Copy EOBs to distribute to the collectors. Identify those with a balance or credit to be resolved to be worked as a priority. Make an additional copy and forward it to Support (temporary process) to confirm collector follow-up.

15. Scan daily payment batch by the facility and save to CBO shared drive for future reference.

16. File original copies by date. Move the prior month’s batch to file and store.

17. Prepare self-pay collection letters for each patient identified as self-pay for each payer. Submit three letter series; if no payments are received and the account ages 120 days, identify the account with TW prefix to prepare to be forwarded to an outside collection agency.

18. Work with the external collection agency to post payments collected on TW accounts.

19. CBO Contact for accounts identified as self-pay.

20. Resolve credit balances monthly. If credits are self-pay, prepare refund request and forward for review, signature, and accounts payable to process refund check to patient.

21. Pull paid accounts monthly from patient files to box and store. Confirm the file is complete and in order before boxing if the file is reviewed during any audit processes.

22. Identify any internal/external changes, processes, procedures, etc. that may create reimbursement issues.

23. Assists other CBO employees as necessary.

24. Performs all other duties as assigned.

POSITION QUALIFICATIONS:

EDUCATION:

• A high school diploma is required

• One to two years college preferred.

EXPERIENCE:

• Minimum of one (1) year of experience in a hospital business office setting, or at least one year of experience in the medical billing/collection field.

LICENSURE/CERTIFICATION:

• None required