Work direct with the accounts receivable and related processes and applications in an outpatient substance abuse and mental health facility. Assist with all aspects of the billing cycle, cash receipts, maintenance of accounts, and successful reduction in outstanding balances. Handle accounts receivable reconciliations, uncollected accounts, resolve issues, and collections.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Includes the following, other duties may be assigned:
- Assist in the processing of daily medical claims in accordance with census data
- Assist in daily application of cash receipts, maintaining proper cash controls
- Responsible for maintaining timely and accurate patient accounts
- Process claim adjustments, insurance take backs, and write-offs including contractual allowances
- Review and resolve uncollected accounts
- Identify and respond to patterns of denials or billing practices and perform complex account investigation as needed to achieve resolution
- Coordinate appealing carrier denials
- Responsible for account inquires and reporting, including the generation of account statements and ad hoc reporting
- Ensure all patient Verification of Benefits are being performed
- Analyzing and interpret payer specific claim submission requirements
- Assist department with establishing policies and procedures
- Effectively interact with accounting, clinical, and admission staff as well as management
- Experience in medical claims processing, tracking, and collections required
- Experience in precertification and utilization review processes a plus
- Special projects as required
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.
EDUCATION and/or EXPERIENCE
Bachelor's degree (B. A.) from four-year college or university with minimum of five years related experience and/or training; or equivalent combination of education and experience. Demonstrated proficiency in use of PC to include ability to perform spreadsheet, word processing, and email applications. Must be proficient in MS Office applications, especially Excel. Knowledge of medical billing terms/concepts. Experience with EMR/EHR and Medical Billing applications. Knowledge of Precertification and Utilization Reviews a plus.
Must have excellent oral and written communication skills. Ability to write business correspondence. Ability to respond to questions from management, patients, payers, and external business contacts.
Ability to define and solve problems, establish facts and draw valid conclusions.
Must have excellent organizational skills, be detailed oriented, accurate, and thorough. Must be able to multi-task, possess strong time management skills, ability to prioritize, and follow-up. Must be trustworthy, reliable, and maintain confidentiality. Willing to step outside the boundaries of the job description when necessary. Possess a positive attitude and be a team player. Must be able to effectively manage staff, resolve conflict appropriately and professionally, and maintain/enhance department’s efficiency and productivity.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to sit; use hands to finger, handle, or feel; and talk or hear. The employee frequently is required to reach with hands and arms. The employee is occasionally required to walk. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The noise level in the work environment is usually quiet.