Presbyterian Healthcare Services - Albuquerque, NM

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Minimum Skills/Requirements

High School degree or GED is required, short-term training on insurance collections and claims processing. Minimum six months experience in insurance follow-up. One year of similar medical facility, physician’s office or experience with major carrier in claims processing preferred. Demonstrated ability to communicate effectively via telephone and in writing. Computer literate. Must be able to work closely with coworkers.

Requires detailed knowledge of insurance filing and healthcare billing systems. Responsible for familiarizing self with reimbursement rates, filing limits, and other contract specific guidelines that pertain to collections. Thorough knowledge of insurance collection techniques. Responsible for familiarizing self with basic collection techniques, as well as advanced account resolution techniques. Must be familiar with Windows-based environment, Internet & E-mail.

Primary Job Functions

Performs accounts receivable follow-up activities for their assigned payers/accounts using monthly aged account work queues and/or A/R reports.

Responsible for identifying and documenting insurance payor issues as they arise. Must communicate all issues to teammates and supervisor. Responsible for maintaining a file containing all pertinent information for each issue to include correspondence, EOB's, claims, etc.

Must be an effective team member with good communication skills. Must participate in team meetings, communicate work related ideas and concerns proactively, and assist in finding appropriate resolutions.

Responsible for contacting insurance companies, patients, and employers regarding outstanding hospital claims. Responsible for providing any information (medical records, itemized statements, etc) requested by insurance companies to process claims. Must maintain a system to ensure timely follow-up is completed for each outstanding claim.

Maintain collection reports consisting of outstanding accounts assigned. Must work and document report according to Patient Accounting Department policies and procedures. Responsible for following up on all accounts listed on the report until resolved.

Refer accounts, in accordance with PHS guidelines, to manager for write-off, agency, or attorney referral. Refer difficult claims to supervisor or manager for advice and/or assistance.

Must work closely with all outside agencies contracted with the Patient Accounting Department and assist them with account resolution for any accounts assigned to them by the manager.

Cross train in the various Patient Accounting Department areas to be completely familiar with all aspects of patient accounting functions as they relate to collections.

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