From coast to coast, Rural/Metro employees are tied together by their overwhelming desire to help others. Every day and every call for our team of highly-trained professionals is different than the one before.
At Rural/Metro, we celebrate the successes of our team members, and doing the right thing for those we serve.
Rural/Metro is a leader in private ambulance and fire protection services in 21 states and more than 700 communities nationwide. Rural/Metro has provided high-quality patient care, met and exceeded the expectations of the communities we serve, and invested in the success of our employees since 1948.
Job Summary: Reporting to the Patient Accounts Supervisor and Lead, individual will be responsible for follow up on Medicaid/AHCCCS, Medicare, Commercial Insurance and Contracted claims directly with the payers
• Responsible for making outbound phone calls to payer for follow-up of payment when working tickler files.
• Review and process all incoming remits, processing payer correspondence and patient correspondence.
• Ensure that all federal and payer guidelines are being met when submitting claims.
• Work directly with payers or provider representatives to resolve any payer issues.
• Process accounts correctly, following all federal payer requirements as well as Commercial payers and contracts billing guidelines.
• Manage workload to meet overall department objective set by management.
• Request cash adjustments and refunds accurately and timely based on R/M policies and payer requirements.
• Tickler files may be reassigned or additional task assigned at any time by the supervisor.
• Cross train to assist within the department or other departments for special projects.
• Ability to recognize payer trends and issues. If/When a payer trend is discovered that will have an immediate impact on incoming cash flow, notify supervisor.
• Works each denial as appropriate
• Provides or arranges for additional information as needed
• Submits corrected claims or appeals
• Requests Medicare hearings, when appropriate
• Bills a supplemental payer, the customer or adjusts the account
• Processes refunds to Medicare, when necessary
• Handles all Medicare correspondence
• Assist customer service in an efficient and helpful manner
• Post transactions to software system or computer files
• File or retrieve reports and records as needed
• Respond to requests for information
• Mail medical claims and correspondence as needed
• Make decisions and take appropriate actions based on sound reasoning and judgment.
• Contribute ideas; strive to enhance team effectiveness and support decisions made by the team.
• Plan and perform work systematically and efficiently.
• Carry out instructions, maintain a positive attitude, and support company policies/procedures.
• Punctuality and availability for workload.
• Comply with HIPAA guidelines
• Effectively work through denial/appeal process and meeting filing requirements
• Attend and maintain all required R/M training Customer Service
• The ability to provide service and quality communications exhibiting a professional attitude at all times.
• Complies and enforces all policies and procedures.
• Ensures and inspects paperwork for accuracy and compliance.
• Responsible for escalating concerns regarding questionable paperwork to appropriate management.
• Has successfully completed all required Compliance Training within the required time period.
• Has had no compliance related corrective action during the current review period.
• All other duties as assigned or administered
• Ability to read, write and speak English in an easily understood manner.
• Ability to type 40-50 wpm
• Strong medical terminology background.
• Basic understanding of HCPC codes and service levels
• Detail Orientation – proper keying of codes for charges and billing information and prompt expedition of paperwork
• Knowledge of HCRA 1500 forms and Medicare guidelines are essential for completion of the data entry process
• High school diploma or GED
• This position can require long periods of sitting at a computer workstation. Must be able to lift up to 20 pounds when needed and move object/materials to locations that might be up to 20 feet away.
• General Office Equipment
• The work to be performed will be done in an office environment.
Closing Statement: This brief summary is not an all-inclusive description of job duties. Other job duties and responsibilities may also be assigned by the incumbent’s supervisor at any time based upon Company need. Rural/Metro is a proud Equal Opportunity employer, m/f/d/v.
Rural/Metro Corporation - 19 months ago