· Processing insurance reimbursement collection efforts based on assigned payer of responsibility and eliminates any barriers for timely and correct reimbursement.
· Resolves and/or resubmits rejected or denied claims appropriately as necessary or described by Supervisor or Manager. Protects and defends contract terms, Letters of Agreement and Rate Agreements.
The Ideal Candidate will
· Have with experience with non-government payors preferred, including eligibility inquiries, billing and claim submission experience;
· Have experience with Medicare and/or Government payors preferred, including eligibility inquiries, billing and claim submission experience; &
· Have experience with Medicaid/Medicaid HMO payors preferred, including eligibility inquiries, billing and claim submission experience.
· Utilizing One-Time Resolution works all assigned insurance payers to ensure prompt and proper reimbursement on patient accounts. Makes outbound calls and/or utilizes payer portals, payer website or 277 Transmission Code Sets for status. Ensures proper escalation is performed when account receivable is not collected in a timely manner. Documents the billing, follow-up and/or collection efforts. Ensures follow-up and follow through are met consistently, per protocol, on outstanding receivables.
· Analyzes work lists and/or reports daily (denials, underpayments) to appropriately resolve issues. Responds to written correspondence received from payer and/or patients. Is responsible to stay current on all active, assigned accounts which prevents abandonment, uncollected account receivables.
· Completes account follow-up daily, maintaining established productivity and AR goals, and notifies Supervisor, when necessary, of issues preventing achievement of such goal(s). Ensures AR <120 and Cash goals are met.
· Processes or requests adjustments to accounts, based on authorized threshold amounts, which have been deemed uncollectable, using proper format.
· Reviews contracts to determine if payments are appropriate; defends contract terms, Letters of Agreement and Rate Agreements.
Credentials and Qualifications:
· High School Diploma/GED.
· Three (3) years medical collections experience in a hospital or physician business office setting.
· Working proficiency in Microsoft Office applications, i.e. Word, Excel, PowerPoint, and Outlook.