This Payment Review Representative is primarily responsible for reviewing and analyzing the root cause of, and resolving all credit balances on patients accounts.
Ensure the prompt, accurate, and proper handling of account receivables credit
Ensures daily account workload is completed prior to day’s end
Identifies and reports trends
Essential Duties & Responsibilities:
Responsible for the review, reconciliation and resolution of accounts listed on the credit balance work list
Review requests for refunds/offsets to ensure that all efforts are reported and accurate
Take necessary action to follow-up on assigned accounts including contractual adjustments, patient balance transfers, and completion of refund request
Identify and report credit balances due to information incorrectly loaded in the MedAssets Contract Management tool
Process assigned accounts for refunds with correct insurance codes, allowance codes and financial classes
Identify and report any payment or adjustment posting trends or issues
Identify trends in payor overpayments and escalate to the Supervisor to determine the required action steps to reconcile the issue with the payor
Post contractual allowances as needed in the system when the variance is determined to be an incorrect allowance taken
Post accurate and timely notes to the system for all action taken on the account
Maintain knowledge of payor contracts and federal regulations
Maintains unit/team specific productivity expectations per policy
Adheres to department quality assurance expectations per policy
Keep current with all government payor regulations and provider/payor contracts
Act cooperatively and responsibly with patients, visitors, co-workers, management and clients.
Maintain a professional attitude.
Maintain confidentiality at all times.
Minimum Qualifications & Competencies:
BA/BS in business or related concentration, some college preferred
Minimum 2 years experience in healthcare insurance collections field
AAHAM(American Association of Healthcare Administrative Management) Certification preferred
Proven knowledge and experience in hospital or physician patient accounting systems, preferably Siemens SMS and/or Affinity
Experience working with customer support/client issue resolution management
Must be able to multi-task and work in a fluid and dynamic setting
Excellent oral and written communications skills
Demonstrated ability to work in a team environment that requires quick turnaround and quality output
Solid knowledge of all MS Office Products
Travel: 0% travel required/expected
MedAssets is an Equal Opportunity Employer and ensures its employment decisions comply with principles embodied in Title VII, the Age Discrimination in Employment Act, the Rehabilitation Act of 1973, the Vietnam Veterans Readjustment Assistance Act of 1974, Executive Order 11246, Revised Order Number 4, and applicable state regulations.
MedAssets is at the center of improving the quality and effectiveness of the healthcare industry. From establishing best practice value for...