High School graduate or equivalent required
The primary purpose of this position is to coordinate and facilitate all billing and collection activities (including electronic and hard copy billing) by following the patient’s account through the billing process to the payor, working with the payor through claims processing to accurate reimbursement for hospital. This position has a general understanding of all functions in the Patient Financial Services department in order to provide outstanding customer services and answer billing questions for any customer.
1. Ability to provide exemplary customer service while working with patients, and/or guarantors, and insurance companies appropriately concerning billing issues. Demonstrates positive interpersonal communication skills relating to internal and external customers on the telephone. Communicates in a courteous, accurate and honest manner. Handles customer service complaints in a professional manner. Adheres to Cheyenne Regional Medical Center Service Excellence standards.
2. Submits all claims, both electronically and hard copy, in a timely manner. Works assigned aging reports weekly. Verification and posting of all payments and adjustments in a timely manner. Provides feedback to management regarding edits needed to the billing editors, and or process improvement to remove barriers for complete and accurate account resolution.
3. Ability to evaluate payor remits and denials for accuracy according to individual contracts and pursue reimbursement on accounts with general understanding of CPT , HCPCS, ICD-9 and revenue codes. Must have knowledge of general insurance laws, guidelines and contract language, knowledge of Medicare, Medicaid, and all commercial insurance programs, including Medicare HMOs and state programs to include filing deadlines, billing requirements, and reimbursement methods. Ability to utilize critical thinking skills to reconcile accounts in a timely manner. Composes and submits appeals to third party payers, appealing to the highest level to resolve account denial for proper reimbursement.
4. Receives and researches patient, payor, attorney, and third party inquiries received through incoming calls and correspondence in a timely manner by reviewing all information available including payor remits, contracts, documentation, policies and procedures, insurance laws and formulates an informative response and directs the account appropriately. Researches and compiles reports as required for audits.
5. Maintains or exceeds Account Receivables (AR) and cash collection goals as established by Senior Management.
6. Pursues and participates in education for assigned payor to remain current with changes in the healthcare industry.
7. Actively participates in all team meetings, including team building activities. Exhibits behaviors that are consistent with Cheyenne Regional’s Mission , Vision and Values
SKILLS, KNOWLEDGE, AND ABILITIES
• Knowledge of federal and state billing and coding regulations, including current understanding of billing compliance regulations and issues.
• Exhibits understanding and knowledge of payor contracts and billing requirements, including government and commercial payors to ensure timely and accurate reimbursement
• Requires critical thinking and analysis skills with knowledge of the revenue cycle, in order to analyze payor denials and determine where there is a need for performance improvement, and provides this information to management.
• Exhibits effective communication skills, especially verbal and written, with the ability to establish and maintain effective, courteous working relationships with patients, staff, management and other customers.
• Knowledge of various computer programs, including billing system, document imaging system, and Microsoft office products, especially Excel and Word.
• Applicable healthcare experience in billing, credit and collections, with emphasis on customer service and finance
• High school diploma or GED
• Associates degree or equivalent experience in a related health care field
• Knowledge of Medical terminology and coding
Cheyenne Regional Medical Center - 5 months ago
Cheyenne Regional Medical Center is a nonprofit, county hospital located in Cheyenne, Wyoming. Established in 1867, CRMC is one of the...