Performs follow-up and collections activities related to one or more of the following financial classes: self-pay, commercial insurance, Medicare, Worker's Compensation (WC), Third Party Liability (TPL).
· Performs follow-up and denial management activities related to the collections of outstanding self-pay and/or insurance balances.
· Researches accounts and performs necessary outreach to guarantors, insurance companies and attorneys to ensure timely, accurate payments.
· Resolves account issues including validating accuracy of guarantor statements, resubmitting claims, identifying information needed to correctly process claims and generally working through issues in order to collect payment as expediently as possible.
· Understands and complies with terms of managed care contracts and associated federal/state regulations related to billing and collections, coordination of benefits and subrogation.
· Stays abreast of, and communicates changes in regulations pertaining to guarantor and/or insurance collections.
· Processes and resolves rejections and denials received from third party.
· Documents conversations and correspondence with patients guarantors, insurance representatives, attorneys and other internal/external customers in billing system.
· Receives and responds to incoming customer calls pertaining to billing inquiries and the collection of outstanding receivables.
· Offers payment arrangements to delinquent accounts in accordance with Patient Financial Services (PFS) guidelines.
· Assists in the development and implementation of policies and procedures for the PFS department, when appropriate.
· Reviews and responds to various forms of inquiries from Medicare, providers, members, patients, attorneys, customer service, provider relations, external insurance sources, and other internal customers.
· Manages case load and work queue volumes by following appropriate follow up time lines in accordance with PFS guidelines.
· Participates in the negotiation process for payment according to established departmental criteria, policies and procedures.
· Performs other duties as directed.
• Three (3) years of experience researching and validating commercial primary insurance, health care billing and collections are required.
• Experience in Microsoft NT, Word, Excel, and Access is required.
• Associates degree, or related experience in lieu of degree is required.
• Demonstrated expertise in applicable subject matter, based on assigned production area, is required.
• One (1) year of experience in customer service is required preferred.
• Knowledge of SMS, HSD Diamond, and TPL module is preferred.
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