Responsible for accurate, compliant and timely follow up, resulting in adjudication on all claims submitted to third party carriers/intermediaries and answering inquiries on a timely basis according to hospital policies.
Essential Job Results:
Ensure follow-up of claims on a timely basis and adheres to contractually binding conditions
Daily review system work-list, reports, and/or ATB to resolve accounts which have not been paid within 30 days of claim submission. Contact the appropriate payer to ensure payment is received within 45 days of submission of a clean claim.
Daily review denials and payment discrepancies identified on EOB, RA, or Payer Correspondence. Take necessary action to address denial, determine true payment source and take steps to secure payment.
Collector will identify trends of denials, provide documentation and data, and offer suggestions for process improvement to resolve the issue.
Has thorough working knowledge of the computer system as it pertains to proper registration through collection functions, including Epic, Hworks, NDC/Premis, Denial Management and Archive/Fiche.
Quickly responds to change in insurance requirements and regulations, prioritizing work load and implements all changes immediately.
Has specific working knowledge pertaining to insurance requirements, insuring a clear understanding of insurance company information required facilitating the billing and reimbursement process via multiple systems.
Conduct inquiries via phone, mail, fax, or electronically to conduct follow up on the accounts that have not been paid.
Contact patients for additional information needed to get claim paid.
Verify additional information received, update account in billing systems and generate rebills as needed.
Works with various departments in obtaining additional billing information.
Handle inquiries from carriers and patients regarding claims and ensure they are answered correctly and timely.
Attend meetings with payer representatives to address claim issues
Establish and maintain proficient level of system knowledge
Completes tasks and assignments in a timely manner. Utilizes time in a constructive manner. Able to act independently when necessary.
Utilizes supplies and resources of the organization in a cost-effective manner.
Documents repetitive issues for corrective action.
Maintains follow-up procedures and working relationships with area responsible for the information, including; Medical Records Department, Patient Access, and/or physicians.
Documents activity in an accurate and timely manner on the patient¿s account.
Maintains proficiency and level of knowledge with all systems required for task completion.
Ensures compliance with all state and federal billing regulations and reports any suspected compliance issues to your respective Manager/Supervisor and Education/QA Manager.
Works with supervision, management and the patient accounting staff to improve processes, increase accuracy, create efficiencies and achieve the overall goals of the department.
As requested, participates in general or special assignments.
Attends required training. Completes on-line training as assigned.
Attends meetings with payer representatives and/or vendors to address outstanding issues.
Required: High school graduate or equivalent
Preferred: Associate degree or PFS certification
Experience & Skills:
Required: Minimum of 2 years in Patient Accounting, specifically billing, collections, customer service, or cash application; Able to communicate clearly and professionally; possess strong organization and time management skills, and have excellent interpersonal, verbal, and written communication skills; extensive experience with computers, Patient Accounting / EDI/ Payer sites, and other peripheral systems in use on the ABO, office support programs, and normal office equipment (telephone, fax, copier, voice mail, etc)
Preferred: Working knowledge of Microsoft Office Applications, Medical and Managed Care Contract terminology, and demonstrated knowledge of Revenue Cycle procedures.
Franciscan Alliance offers a comprehensive set of employee benefits including: competitive salary, paid time off, health, dental, vision, life and disability insurance as well as tuition assistance and a savings and retirement plan.
It is the policy of Franciscan Alliance, Inc. to provide equal employment to its employees and qualified applicants for employment regardless of race, color, sex, religion, national origin, veteran status, or physical or mental disability, or as otherwise required by an applicable local or state law. However, Franciscan Alliance, Inc. reserves a Right of Conscience objection in the event local or state ordinances violate its values and the free exercise of its religious rights. Franciscan Alliance, Inc. is committed to the principle of equal employment opportunity.