Analyzes remittances to assure proper posting of payments, denials, adjustments, refunds, and charge corrections to patient accounts; verification of accuracy of both manual and automated postings, including reconciliation of postings against bank deposits and remits receipt of hardcopy electronic remittances; Receipt and optical imaging (scanning) of hardcopy remittances; receipt and deposit of guarantor payments made directly to us; investigation and resolution of accounts with credit balances; billing and collection of client accounts; mail distribution and supply ordering within department; and Patient Accounts portion of Medicare/Medicaid cost reporting logs.
Departmental Quality and Quantity Score
This is derived from the Departmental Quality/Quantity performance rating. Employees are responsible not only for their own specific job duty, but for contributing to the overall success of the Department. The individual employee must have scored no more than one Needs Improvement rating to share in Exceptional ratings in this Departmental score area.
Performs work of appropriate volume for the job assigned while maintaining accuracy
A/R Control Analysts perform one or more of the duties listed below, and does so with appropriate volume and accuracy.
Prepares Patient Accounts’ portion of Medicare/Medicaid cost reporting logs. Requires in-depth knowledge and review of remittance advices and cost reporting rules to properly maintain the logs.
Validates that both manual and automated postings are fully supported by proper documentation. Performs analysis to assure postings reconcile to source documents/files. Researches and resolves posting variances. Effectively utilizes automation to search for variances in large files. Maintains reports to identify and report outstanding, unreconciled items.
Accurately posts payments, denials, and adjustments from remittance advices to the appropriate patient, account, bill and claim. Requires intermediate to advanced math/logic skills to adapt to an almost unlimited variety of remittance formats used by various payers, and to identify and avoid posting of invalid/misleading information. Identifies and reports errors in payer discount calculations related to our major contracted payers…this requires knowledge of those discount terms. Must select the correct payer and financial transaction codes that are specific to that payer.
Creates electronic reports identifying Patient Accounts in credit balance. Prioritizes those credit accounts based upon payer, age of credit, and dollar amount of credit. Determines appropriate reimbursement rules that apply to the case, decides which specific financial transactions (refund, adjustment, etc) need to occur to bring account appropriately to the correct balance, documents rationale for the recommended action. Obtains appropriate approvals for higher-dollar refunds. Identifies problem trends and their root causes to reduce volume of new credits. Maintains knowledge of legal, contractual and governmental program policies related to credit balances and assures compliance.
Receives and reviews Charge Correction requests and posts to appropriate accounts. Requires analysis of proposed corrections to avoid unintentional charge duplication. Involves some logical analysis to detect keying errors such as quantity errors or charge postings that are inconsistent with patient account.
Bills Client Accounts and assures timely and accurate payment of those accounts. Requires excellent communication skills and understanding of the client in order to aid in resolution of charge disputes. Requires excellent follow-up skills to avoid delinquent accounts, and to identify and resolve disputes before they create ill-will or unpaid charges.
Accurate and timely imaging (scanning) of hardcopy remittance advices so that the remit information is electronically available throughout the department, easy to locate and available when we need it.
Receives mail coming into the Department, and accurately distributes it to the appropriate party. Obtains correct supply products and maintains appropriate inventories to support the department’s needs. Exercises good judgement to avoid running out of supplies critical to our work (such as copy paper, claim forms, etc).
Documents receipt of guarantor direct payments and assures these payments are promptly and correctly deposited.
Performs quality of work appropriate to the job assigned while maintaining volume
Performs assigned tasks from Duty 2 above accurately, timely and consistently.
Bachelor's degree from four-year college or university
- Field of Study: Business Administration, Finance or related field
- Experience Substitution: Or four years related experience and/or training; or equivalent combination of education and experience.
1 year total experience required
service or collections, clerical or data entry experience
- which includes 1 year of Problem-solving, analytical, insurance, Medicare or Medicaid,customer
Comfortable with using Personal Computers and software
Data Entry >6000sph with
Ability to communicate effectively by telephone and excellent interpersonal skills
Ability to independently research issues and resolve problems
Knowledge of medical reimbursement
Physical Activity - Stand
Physical Activity - Walk
Physical Activity - Sit
Physical Activity - Use hands to touch, handle, or feel
Physical Activity - Reach with hands and arms
Physical Activity - Stoop, kneel, crouch, crawl, twist, or bend
Physical Activity - Talk or hear
Physical Environment - Inside Office Environment / conditions
Lifting/Pushing/Pulling Weight - Up to 10 pounds
Lifting/Pushing/Pulling Weight - Up to 25 pounds
Noise Level - In general, the noise level for this position is considered to be:
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