PURPOSE AND SCOPE:
Ensures timely receipt of claim payments and minimization of unexpected bad debt by monitoring assigned worklists, working with the appropriate clinical, regional and divisional staff to resolve related issues. Performs Accounts Receivable collection duties as assigned by Billing Group Supervisor, ensuring collection of past due balances to maintain profitability.
Supports FMCNA’s mission, vision, core values and customer service philosophy. Adheres to the FMCNA Compliance Program, including following all regulatory and FMS policy requirements.
DUTIES / ACTIVITIES :
- Responsible for driving the FMS culture though values and customer service standards.
- Accountable for outstanding customer service to all external and internal customers.
- Develops and maintains effective relationships through effective and timely communication.
- Takes initiative and action to respond, resolve and follow up regarding customer service issues with all customers in a timely manner.
PRINCIPAL RESPONSIBILITIES AND DUTIES:
- The Commercial Insurance Aging Work List, which identifies unpaid Commercial claims that have qualified for follow-up.
- Utilizes the Medicare Direct Data Entry system to identify and resolve any claims that have been Returned to Provider (RTP).
- Generates and monitors all work lists specific to the Collections Role, including:
The Remittance Discrepancy Work List, which identifies claims where payment was denied or was less than expected reimbursement.
- The Medicare Insurance Aging Work List, which identifies unpaid Medicare claims that have qualified for follow-up.
- The Overdue Guarantor Aging Work List, which identifies guarantor balances that require follow-up. This includes but is not limited to timely guarantor follow-up and quality documentation of guarantor follow-up activities which will ensure maximization of Medicare Reimbursable bad debt.
- Performs the following duties as required based on follow-up activities:
- Identifies need for insurance changes and completes required forms to initiate request.
- Transfers balances to correct payer.
- Initiates re-bill of unpaid or underpaid claims.
- Processes non cash related adjustments per established guidelines.
- Initiates appeal requests per payer guidelines.
- Notifies the legal department and places collection activity on hold when a bankruptcy notice is received per FMS bankruptcy policy.
- Completes and documents all follow-up activities in eCube Financials per established guidelines.
- Ensures that all Medical Justification Requests are submitted within the established timeline and per the Additional Development Request (ADR) Policy.
- Establishes payer filing limits to ensure that follow-up is completed within the established timeline and claims paid so that denials are not received for claims filed untimely. If necessary, prepares bad debt write-off package with supporting documentation per established guidelines.
- Other duties as assigned.
PHYSICAL DEMANDS AND WORKING CONDITIONS:
The physical demands and 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.
- Able to lift up to 50 lbs. independently with some manipulation of supply and inventory expected.
- Requires sitting and standing for extended periods of time.
- Requires adequate visual acuity, manual dexterity and hearing (with or without accommodation).
- Work environment includes inside work primarily around office equipment.
High School Diploma or Equivalent
EXPERIENCE AND REQUIRED SKILLS:
- 1-2 years healthcare billing or collections experience required with a High School Diploma.
- No experience required with a Healthcare Certificate or 2 or 4 year Degree
- Working knowledge of Windows-based software applications (i.e., Word, Excel).
- Ability to analyze data.
- Excellent written and verbal communication skills.
- Good interpersonal skills and team oriented.
- Well organized and detail oriented.
- Positive attitude, enthusiastic and energetic.
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