Compiles and manages data needed to monitor third party payer performance ensuring accurate reimbursement.
JOB RESPONSIBILITIES (May perform additional duties of similar complexity within SCHS as required or assigned)
Utilize Contract Management system; work daily errors, balance claims/denials/appeals.
Maintain successful working relationships and regularly interface with third party payer representatives and other SCHS departments.
Compile data needed to submit reimbursement appeals to third party payers.
Review and evaluate remittance advices for correct payment.
Review accounts for payment variances.
Review and process account referrals.
Report recoveries and variances weekly for statistics.
Maintain and apply current knowledge of third party payer policies, including Medicare and Medicaid.
Education: High School Diploma or equivalent General Education Diploma
Licensure/Certification/Registration: Not required.
Personal Protective Equipment: Must be able to wear appropriate Personal Protective Equipment (PPE) required to perform the job safely.
Experience: Two years experience in a healthcare setting that demonstrates research, problem solving, analytical and communication skills preferred. Two years experience in hospital billing, reimbursement, hospital information systems, personal computers, and process improvements preferred.