Medicaid/IHS/Insurance Collections Representative
Kalispell Regional Medical Center - Kalispell, MT

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High School/GED
  • As with every position in the Patient Business Services Department, the Medicaid/HIS Insurance Collections Representatives has specific duties directly related to this job description. Additionally, staff members should understand that duties of various department job descriptions will overlap. The entire department shares the responsibility of ensuring accuracy and timeliness in all phases of the billing and collections processes. All staff members must exercise good communication and a willingness to assist others outside of the scope of their job description in order to be successful as a department.

    The Medicaid/HIS Insurance Collections Representative functions as a liaison between patients, Insurance companies, other providers, third party agencies, and the Kalispell Regional Medical Center departments regarding billing questions, payment issues, and other insurance related inquiries.

    The Representative’s primary function is to follow up on all Medicaid and Indian Health Services collections. Facilitate and expedite collection of the accounts receivables via telephone, written documentation, e-mail inquiries, and/or personal visitations with the goal of ensuring patient satisfaction. Review accounts for collectability. Assist patients via telephone inquiries and/or personal visitation ensuring patient satisfaction. Representatives will utilize all means available to maintain current demographic and insurance information. Analyze and interpret account data to allow for claim and payment resolution and, when appropriate, rebilling of claims. Interpret explanation of benefits message codes in order to identify payment discrepancies and resolve or refer to the appropriate party.

    Representatives must effectively process adjustments and refunds in accordance with Kalispell Regional Medical Center’s policies and procedures, when appropriate and necessary. In absence of a specific written policy or procedure, use the Fair Debt Collection Practices Act as a guideline. Manage personal voicemail and email inquiries within 24 hours of receiving messages. Actively manage reminder queue and work aging reports. Enter detail documentation of any and all activity on patient accounts in the appropriate notes section.
    Inform Management of any and all unusual circumstances or occurrences. Maintain a professional, positive and “team-player” attitude. Accept and act upon all duties and/or projects assigned by Management to the best of the Representative’s ability.

    This job objective has been designed to indicate the general nature and level of work performed by employee within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of the employee assigned to the job.

    1 . High school diploma or equivalent education.
    2. Proficient with computers including word processing and spreadsheet software; Meditech
    knowledge preferred.
    3. Basic knowledge of accounting and ten-key by touch.
    4. Verbal and written communication skills.
    5. Ability to work independently and collaboratively.
    6. Ability to establish and maintain effective working relationships with patients, organization
    staff members and the public.
    7. Familiar with medical terminology.
    8. Understands third party payer methodology.
    9. Ability to operate basic office equipment.
    10. Good credit standing

    Job Duties:
    1. The employee demonstrates complete working knowledge and understanding of the Patient Account Billing and AR system software. This includes, but is not limited to:
    •Process Account – enter and edit insurance data, re-bill claims, edit insurance balances, reverse and re-batch transactions, enter reminders and comments.
    •Process Guarantor.
    •Batch processing – enter adjustments, refunds, and charges.
    •Collector Processes – reminder queues, enter multiple comments.
    2. Employee uses reminder queue to prioritize daily work, follow-up on accounts, and alert others to the account. The employee is expected to queue reminders daily to ensure that reminders will be resolved appropriately.
    3. Utilizes a professional/aggressive approach to account management. Takes the initiative to identify problems and trends then researches and proactively seeks solutions based on policy and procedure to ensure all payments are received timely.
    4. Consistently completes daily/weekly work schedules, prioritizes follow up activity to ensure maximum collections through high balance review.
    5. The total dollars in the employee’s aging will be compared to the industry standard: Percentage of accounts over 90 days is 26%, percentage of accounts over 120 days is 16%, percentage of accounts over 151 days is 11%.
    6. The employee will demonstrate the knowledge needed to ensure the aging meets or exceeds this standard. When evaluating, the Supervisor will take into account any extenuating circumstances that may increase days, which may be out of the employee’s control (i.e. a system update that may prevent claims from being final billed, identifiable problem(s) in the HIM department that may prevent accounts from being abstracted); the total dollars in the affected month(s) will be omitted from the calculation.
    7. Proactively and professionally respond to problem solving through inter departmental and external entities (insurance companies, patients) to resolve billing/collection issues.

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