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Job Objective: A brief overview of the position.
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Performs account review, follow-up and collections to include double recoupment, correspondence and credit balance resolution.
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Reports to
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Director of Patient Financial Services and/or Clinic Billing
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Supervises
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N/A
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Ages of Patients
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N/A
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Blood Borne Pathogens
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Minimal/ No Potential
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Qualifications
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Education
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- Required: High school diploma, GED or higher level degree
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Licensure/Certification
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- N/A
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Experience
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- Required: One (1) year of billing/collections experience, billing certification or prior successful internship/temporary assignment in a patient financial service setting
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- Preferred: Experience with managed care and Medicare/Medi-Cal Billing regulations
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Essential Responsibilities
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Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.
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Manages new accounts, on a daily basis, by working within Receivables Workstation. Interfaces with other departments within the hospital, when appropriate, to obtain information necessary to process or resolve claims. Contacts patient and/or account guarantor to solicit payment on account.
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Works all accounts listed in the Follow-Up queue, on a daily basis to promote collection of accounts. This will include telephoning the payer, messaging or identifying the claim on the payers’ Internet websites.
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Manages account inventory on a timely basis to promote payment and resolution of all accounts as instructed by management.
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Stays current on all payer requirements by reading bulletins, reviewing provider handbooks, accessing websites, etc.
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Processes incoming correspondence, including signature letters, denials, prior authorizations and additional information necessary to process the claim.
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Records newly identified insurance plans and facilitates the account processing of new plan in accordance with pre-billing policies and procedures.
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Records accurate and definitive notes in the electronic account file that depict the current status of account, issues with account and anticipated date of resolution.
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Escalates account management to Supervisor when issues arise, if needed.
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Ensures PFS management is kept up to date with contract, payer or system changes and/or issues.
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Assigns a status code to each worked account to enable account tracking, statistical data gathering and audit activities.
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Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance.
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Handles special projects as directed by management e.g. high dollar accounts, accounts over 180 days old, etc.
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Attends, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines as requested.
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Maintains productivity standards by payer assignment.
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Performs other job related tasks as assigned.
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Located in the heart of the Coachella Valley, you have access to resort-style living and world-class amenities throughout Southern California.
