group
Category
Administrative Support
business
Department
Clinic Billing Services
date_range
Schedule
Full Time
schedule
Shift
Day
timer
Hours
8 Hour Shift
place
Location
Rancho Mirage, CA
info
Job #
R0252242




  • Job Objective: A brief overview of the position.



    • Works under the direction of the Billing Manager. Performs follow-up and collection of unpaid insurance claims including contracts and commercial carriers as well as self-pay accounts. Responsible for routine and timely follow-up until the insurance carrier correctly reimburses claims. Processes claim adjustments and refunds when appropriate and reacts to incoming mail and telephone calls regarding the assigned claims and patient bills. Responsible for updating, noting and maintaining the integrity of the account files.


  • Reports to



    • Billing Manager


  • Supervises



    • N/A


  • Ages of Patients



    • N/A


  • Blood Borne Pathogens



    • Minimal/ No Potential


  • Qualifications



    • Education



      • Required: N/A


      • Preferred: Some college preferred


    • Licensure/Certification



      • N/A


    • Experience



      • Required: Three years prior experience in a clinic or hospital setting; 5 years experience in a clinic, payer or collection agency setting may be substituted; must have working knowledge of managed care, must have knowledge of billing regulations; must be computer literate,


      • Preferred: N/A


  • Essential Responsibilities



    • Demonstrates compliance with Code of Conduct and compliance policies, and takes action to resolve compliance questions or concerns and report suspected violations.


    • Manages new accounts, on a daily basis, by contacting payer to determine if the account has been received and/or if additional information is required. Assigns follow-up dates in accordance with follow-up guidelines.


    • Account resolution of all self-pay accounts including self-pay after insurance.


    • Manages new credit balance accounts every day and prepares adjustments or refunds to zero the account balance


    • Works all accounts listed in the Follow-Up cue, on a daily basis to promote collection of accounts. This will include telephoning the payer or identifying the claim on the payers’ Internet location.


    • Manages entire account inventory on a timely basis to promote payment and resolution of all accounts prior to ninety days from date of billing.


    • Answers incoming telephone call from patients who call with questions/information regarding their bills


    • Responds appropriately to incoming mail from patients or payers regarding their assigned accounts


    • Processes incoming hard copy explanation of benefits and reacts appropriately to resolve the accounts.


    • 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.


    • Escalates account management to manager when extraordinary issues arise.


    • Obtains and records "Promise to Pay" amounts on a daily basis that are consistent with the cash collection goals of the department


    • Assigns a status codes to each worked account to enable account tracking, statistical data gathering and audit activities.


    • Identifies work unit issues and participates in solutions and problem solving by working with manager and staff members.


    • Attends staff meeting, in-house training and attends classes pertaining to Federal and State billing regulations as well as Compliance Issues and Guidelines when requested

    • Performs other job related tasks as assigned by Supervisor.

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