Hospital Billing Specialist - Medicare

CONIFER REVENUE CYCLE SOLUTIONS LLC • Frisco, TX • 2w ago

Description

JOB SUMMARY

The Patient Account Representative is responsible for working accounts to ensure they are resolved in a timely manner. This candidate should have a solid understanding of the Revenue Cycle as it relates to the entire life of a patient account from creation to payment. Representative will need to effectively follow-up on claim submission, remittance review for insurance collections, create and pursue disputed balances from both government and non-government entities. Basic knowledge of Commercial, Managed Care, Medicare and Medicaid insurance is preferable. An effective revenue cycle process is achieved with working as part of a dynamic team and the ability to adapt and grow in an environment where work assignments may change frequently while resolving accounts with minimal assistance.

Representative must be able to work independently as well as work closely with management and team to take appropriate steps to resolve an account. Team member should possess the following:

Perform duties as assigned in a professional demeanor, which includes interacting with insurance plans, patients, physicians, attorneys and team members as needed.

Basic computer skills to navigate through the various system applications provided for additional resources in determining account actions

Access payer websites and discern pertinent data to resolve accounts

Utilize all available job aids provided for appropriateness in Patient Accounting processes

Document clear and concise notes in the patient accounting system regarding claim status and any actions taken on an account

Maintain department daily productivity goals in completing a set number of accounts while also meeting quality standards as determined by leadership

Identify and communicate any issues including system access, payor behavior, account work-flow inconsistencies or any other insurance collection opportunities

Provide support for team members that may be absent or backlogged

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following. Others may be assigned.

Researches each account using company patient accounting applications and internet resources that are made available. Conducts appropriate account activity on uncollected account balances with contacting third party payors and/or patients via phone, e-mail, or online. Problem solves issues and creates resolution that will bring in revenue eliminating re-work. Updates plan IDs, adjusts patient or payor demographic/insurance information, notates account in detail, identifies payor issues and trends and solves re-coup issues. Requests additional information from patients, medical records, and other needed documentation upon request from payors. Reviews contracts and identify billing or coding issues and request re-bills, secondary billing, or corrected bills as needed. Takes appropriate action to bring about account resolution timely or opens a dispute record to have the account further researched and substantiated for continued collection. Maintains desk inventory to remain current without backlog while achieving productivity and quality standards.

Perform special projects and other duties as needed. Assists with special projects as assigned, documents, findings, and communicates results.

Recognizes potential delays and trends with payors such as corrective actions and responds to avoid A/R aging. Escalates payment delays/ problem aged account timely to Supervisor.

Participate and attend meetings, training seminars and in-services to develop job knowledge.

Respond timely to emails and telephone messages as appropriate.

Ensures compliance with State and Federal Laws Regulations for Managed Care and other Third-Party Payors.

Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings.

KNOWLEDGE, SKILLS, ABILITIES

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Thorough understanding of the revenue cycle process, from patient access (authorization, admissions) through Patient Financial Services (billing, insurance appeals, collections) procedures and policies

Intermediate skill in Microsoft Office (Word, Excel)

Ability to learn hospital systems - ACE, VI Web, IMaCS, OnDemand quickly and fluently

Ability to communicate in a clear and professional manner

Must have good oral and written skills

Strong interpersonal skills

Above average analytical and critical thinking skills

Ability to make sound decisions

Has a full understanding of the Commercial, Managed Care, Medicare and Medicaid collections, Intermediate knowledge of Managed Care contracts, Contract Language and Federal and State requirements for government payors

Familiar with terms such as HMO, PPO, IPA and Capitation and how these payors process claims.

Intermediate understanding of EOB.

Intermediate understanding of Hospital billing form requirements (UB04) and familiar with the HCFA 1500 forms.

Ability to problem solve, prioritize duties and follow-through completely with assigned tasks.

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