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About the Role

Responsible for reviewing assigned third-party and/or patient accounts, ensuring timely billing and payment from responsible payers, and documenting account/claim status and actions in patient accounting systems. Identifies, communicates, and escalates complex claim issues and billing/payment trends, recommending solutions to leadership.

Responsibilities

• Review hospital accounts assigned by system generated work-queues or reports to determine appropriate actions for moving accounts forward in the revenue cycle.
• Initiate phone calls, submit website inquiries, write letters of appeal to payers, and make inquiries to patients.
• Recommend write offs and adjustments.
• Ensure account balances are valued as per payers’ contracts.
• Meet and/or exceed productivity and quality standards.
• Perform root cause analyses on accounts with a solutions focus.
• Track trends and escalate carrier or revenue cycle system issues to the Team Lead and/or Supervisor.
• Participate in projects and audits as directed by leadership.
• Collect and assemble financial documents related to billing and payment to substantiate services and reimbursement.
• Collaborate with internal departments, external vendors, and IT for issue resolution and operational effectiveness.
• Meet with Team Lead/Supervisor to discuss and resolve billing obstacles, reimbursement issues, and process improvements.
• Monitor accounts for timely filing guidelines and prioritize work accordingly.
• Ensure claims are compliant, meet payer requirements, and resolve billing errors/claim rejections timely to minimize financial losses.
• Escalate and report any delays in claims adjudication.
• Assess payments (or lack of) and adjustments for accuracy and timeliness.
• Understand and review payer reimbursement systems/contracts to establish accuracy in the A/R.
• Review regulatory and contract updates to understand impacts to reimbursement from federal, state, and managed care payers.
• Correct transactions and transfer balances to responsible parties as necessary.
• Report and document on-going issues to management.
• Promote and deliver positive patient experience and patient satisfaction.
• Perform other duties as assigned.
• Adhere to all organizational policies and procedures.

Requirements

• Competent in a variety of patient accounting systems and associated applications.
• Strong knowledge of third-party operations and reimbursement structures.
• Knowledgeable in medical terminology, CPT, HCPCS, and ICD10 coding used in healthcare.
• Ability to work independently, exercising good judgment, and multi-task in a high stress, fast-paced, and ever-changing service environment with patients, patient’s family, insurance carriers, and leadership.
• Detail-oriented with solid analytical problem-solving skills.
• Excellent customer service skills to communicate effectively with payers, patients, and colleagues.
• Excellent communication skills including oral and written comprehension/expression.
• Ability to maintain professional conduct and good working relationships with staff, management, and payers.
• Microsoft Office proficiency, subject to testing.
• Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the usual and customary.

Skills

• Patient accounting systems
• Third-party operations
• Reimbursement structures
• Medical terminology
• CPT coding
• HCPCS coding
• ICD10 coding
• Analytical problem-solving
• Customer service
• Communication (oral and written)
• Microsoft Office
• EHR experience (Epic preferred)

Experience Level

• A minimum of two years' experience in healthcare billing, healthcare customer service, or a related field required.

Education Level

• High School diploma or equivalent required.

Salary/Compensations

• USD $24.00 - USD $30.00 /Hr.