Reimbursement Coordinator
Visiting Nurse Health System - Atlanta, GA

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Job Description:

The Reimbursement Coordinator’s responsibilities include coordinating assigned patients’ insurance qualification process and collection procedures; gathers data for financial assessments; liaison between patients, contract payors and other health care providers relative to financial issues; performs receivables management, billing and collections duties.

EDUCATION REQUIREMENTS: High School Diploma with experience in business related field. Degree of higher learning a plus.

EXPERIENCE REQUIREMENTS: 3 -5 years experience in billing and receivables management. Specific experience with home health nursing, therapies, durable medical equipment, pharmacy & third party payers is helpful.

JOB KNOWLEDGE: Professional knowledge of healthcare financial case management & managed care with emphasis on billing and receivables management. Specific experience in billing Medicare A & B, Medicaid, 3rd party payers and other funding source regulations as they apply to home health and Hospice. Strong written & oral communication skills and ability to deal with both internal and external customers. This includes team members, patients, families, referral and community resources. Must be proficient in use of personal computers to include basic office automation such as spread sheets and word processing software. Ability to manage and be responsible for entire patient financial concern from referral through discharge. Ability to manage several functions simultaneously and work independently within a team environment.

Transportation: Must have reliable transportation.

• Verifies services billed, attaches medical documentation as requested by payor and mails.
• Documents all phone calls and actions taken on the account in question and maintains in
• appropriate account folder & computer system.
• Maintains accurate record keeping system in order to reproduce billing documents and payor
• correspondence as any customer may require.
Patient Information
• Updates patient financial information in Companys computer system.
• Using given parameters, quotes preferred pricing to payor case managers.
• Participates in interdisciplinary patient case conferences as applicable.
• Upon request, gathers patient financial data for the completion of the Financial Assessment Form.
Reimbursement Coordination
• Generates and reviews system generated invoices, statements, UB-92's, 1500's and other various reports for manual & electronic claim transmission for accuracy. Makes necessary corrections appropriate to the payors billing parameters.
• Knowledge of CPT & revenue codes.
• Reviews all remittance and payor correspondence, resolves problems and maintains all records to ensure proper audit. Performs re-billing if applicable.
Claim Maintenance
• Manually prepares & posts payments, transfers, adjustments & late charges on-line.
• Maintains claim maintenance, generates late charges to appropriate payor.
• Performs Medicare eligibility monthly.
• Follows-up on unpaid accounts by appropriate use of telephone, letters, statements, collection agencies, etc.
• Monitors exception reports to ensure prompt and accurate handling of all accounts.
• Monitors authorization notices and communicates with clinical staff when authorization is missing or medical documentation is needed.
• Communicates patient financial information to appropriate personnel and payor sources.
• Informs patient, family and work team members regarding insurance, financial and billing related issues.
Insurance Verification
• Upon referral, verifies eligibility coverage and obtains initial pre-authorization with insurers if needed.
• Verifies services billed, attaches medical documentation as requested by payor and mails.
• Maintains current knowledge of, and compliance with federal, state and local regulations concerning billing and collection.
• Demonstrates knowledge of contracts and managed care agreements.
Visiting Nurse Health System, Georgia’s largest nonprofit provider of healthcare and hospice at home, 64 year tradition of serving its mission of improving the lives of those we serve. Our vision is to set the standard for quality in Georgia and be the first place patients, families, payers and other healthcare providers select when in need of homecare or hospice services.
Each year Visiting Nurse Health System provides professional clinical and care management services to more than 25,000 patients in metropolitan Atlanta.
Visiting Nurse Health System is an EOE.

Visiting Nurse Health System - 2 years ago - save job
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Visiting Nurse is the leading provider of home healthcare and hospice care in Atlanta, Georgia, helping patients successfully manage their...