Position Status:
Full time
Shift:
First Shift (Days - Less than 12 hours per shift) (United States of America)
Hours per week:
40
Job Information
Exemption Status: Non-Exempt
A Brief Overview
The individual in this role is a key member of the financial team by coordinating the billing functions with a group of employees who perform fairly complex claim submission tasks which are completed to ensure: (1) accurate and timely claim submission to the appropriate third party payors; (2) submitted claims are incompliance with federal/state laws and contractual obligations; (3) maximum customer satisfaction; and (4) maximized cash flow. The incumbent is also responsible for identifying claims that fail both internal and external billing edits and taking the appropriate action to reduce the number of claims that fail the billing edits. The individual in this role is responsible for tracking and analyzing payment denials and underpaid claims from all third party payers, appealing denial and under paid claims to obtain payment, coordinating with clinical departments to write appeals regarding medical necessity, and recommending improvements in processes to reduce denials. These activities are completed following established policies and procedures, and in compliance with Joint Commission, Medicare, Payer contracts, HIPAA, regulatory agencies and the organization's Code of Conduct.
Education Qualifications
- High School Diploma / GED Required
- Bachelor's Degree Business, accounting, finance or a related field. Preferred
Experience Qualifications
- 2 years Experience in a clinical healthcare setting such as physician's office or hospital relating to patient financial services, patient registration, patient scheduling or related healthcare. Required
Skills and Abilities
- Knowledge of major third-party billing and contract requirements. (Required proficiency)
- Working knowledge of basic medical terminology. Understanding of medical/clinical treatment processes. (Preferred proficiency)
- Keyboarding skill or typing skill of at least 30 wpm. (Preferred proficiency)
- Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond to questions from management, physicians, employees and the general public.
- Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, percentages. Ability to apply concepts of basic Algebra.
- Ability to read, analyze and interpret general business periodicals, professional journals, technical procedures or government regulations. Superior written and oral communication skills. Ability to effectively present information and respond.
What you will do
- Generates re-bills after all edits have been resolved and re-submits claims to third-party payors. Identifies missing or incorrect requirements of rejected claims and either resolves or forwards promptly to appropriate staff for resolution. Completes manual billing process for claims that cannot be sent electronically.
- Identifies and correctly resolves all electronic claim edit failures in a timely manner. Works with clearinghouse as needed for correction and compliance of clearinghouse edits. Identifies and correctly resolves claims in a timely manner that were generated with inaccurate information.
- Effectively writes appeals to obtain payment or effectively coordinates with clinical departments to write appeals regarding medical necessity. Follows up with third-party payers on appeals in a timely manner until issues is resolved. Effectively writes appeals to obtain payment on underpaid claims.
- Identifies and notifies management of potential process/system problems that cause third-party payer payment errors. Identifies and recommends new programs, computer system updates, computer applications and procedural changes to improve (1) reduce third-party payer denials, (2) customer relations and, (3) efficiency of operations.
- Completes analysis of changes in billing rules, policies and procedures in a timely manner and effectively communicates changes to all appropriate staff.
- Ensures customer concerns are processed in compliance with SVHC policies while maintaining the highest level of patient and employee rights, including confidentiality of patient information and personnel issues.
- Collects data and prepares timely reports to facilitate staff monitoring and maintenance of departmental compliance and productivity standards.
- Reads and comprehends Medicare newsletters from the Medicare Administrative Contractor, correspondence from other third-party payers and monthly trade subscriptions, to keep abreast of new regulations, policies, and payment methodologies.
- Analyzes third-party denials and recommends improvements in processes to reduce denials. Analyzes third-party underpaid claims. Confirms payers’ receipt of claims via acknowledgment reports or manually as required.
- Actively pursues the identification, development and implementation of improved processes within the revenue cycle.
- Identifies, obtains and submits required attachments for insurance (i.e. medical records, prior-authorizations, etc.).
- Reviews Hospital cards/interface charges/electronic charge sheets, etc. for accuracy and resolves missing/incorrect information as necessary.
- Reviews and resolves unbilled encounter report.
- Promptly identifies and corrects reoccurring problems by working with third party payors or forwarding to appropriate staff for resolution.
- Ensures the coordination of ongoing staff training and educational development programs with the educational/training staff through staff needs identification and assessment.
- Effectively functions as liaison between team, other team leaders, PFS management, physicians or other departments within the organization. Effectively coordinates team input to department management related to the development, analysis and maintenance of departmental budget. Effectively coordinates team input to department management related to statistical analysis (work performance issues, quality improvement projects, etc.
Required for All Jobs
- Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health
- Performs other duties as assigned
Patient Facing Options
- Position is Not Patient Facing
Remote Work Guidelines
- Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards.
- Stable access to electricity and a minimum of 25mb upload and internet speed.
- Dedicate full attention to the job duties and communication with others during working hours.
- Adhere to break and attendance schedules agreed upon with supervisor.
- Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.
Remote Work Capability
Scope
- No Supervisory Responsibility
- No Budget Responsibility No Budget Responsibility
Physical Demands
- Balancing: Occasionally 1-3 Hours
- Carrying: Occasionally 1-3 Hours
- Climbing (Stairs): Rarely less than 1 hour
- Crouching: Rarely less than 1 hour
- Eye/Hand/Foot Coordination: Frequently 3-5 Hours
- Feeling: Occasionally 1-3 Hours
- Grasping (Fine Motor): Frequently 3-5 Hours
- Grasping (Gross Hand): Occasionally 1-3 Hours
- Handling: Occasionally 1-3 Hours
- Hearing: Frequently 3-5 Hours
- Kneeling: Rarely less than 1 hour
- Lifting: Occasionally 1-3 Hours up to 10 lbs
- Pulling: Occasionally 1-3 Hours up to 10 lbs
- Pushing: Occasionally 1-3 Hours up to 10 lbs
- Reaching (Forward): Occasionally 1-3 Hours up to 10 lbs
- Reaching (Overhead): Occasionally 1-3 Hours up to 10 lbs
- Repetitive Motions: Frequently 3-5 Hours
- Sitting: Continuously greater than 5 hours
- Standing: Occasionally 1-3 Hours
- Stooping: Rarely less than 1 hour
- Talking: Frequently 3-5 Hours
- Walking: Occasionally 1-3 Hours
Working Conditions
- Infectious Diseases: Rarely less than 1 hour
- Noise/Sounds: Occasionally 1-3 Hours
Stormont Vail is an equal opportunity employer and adheres to the philosophy and practice of providing equal opportunities for all employees and prospective employees, without regard to the following classifications: race, color, ethnicity, sex, sexual orientation, gender identity and expression, religion, national origin, citizenship, age, marital status, uniformed service, disability or genetic information. This applies to all aspects of employment practices including hiring, firing, pay, benefits, promotions, lateral movements, job training, and any other terms or conditions of employment.
Retaliation is prohibited against any person who files a claim of discrimination, participates in a discrimination investigation, or otherwise opposes an unlawful employment act based upon the above classifications.
