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
Under direction, responsible for the processing of patient accounts after initial bill submission to final 4rd party payment resolution. This responsibility includes timely and accurate resolution of denied claims, insurance correspondence and follow-up on unpaid claims that exceed the clean claim payment cycle. These activities are completed following established policies and procedures in compliance with Joint Commission, Medicare, Payer contracts, HIPAA, regulatory agencies and the organizations Cod of Conduct.
Education Qualifications
- High School Diploma / GED Required
- Associate's Degree Preferred
Experience Qualifications
- 1 year experience in healthcare financial services, healthcare registration services or related healthcare experience. Required
Skills and Abilities
- Working knowledge of basic medical terminology preferred. (Required proficiency)
- Detailed knowledge of major third-party billing and contract requirements. (Required proficiency)
- Excellent customer service skills. (Required proficiency)
What you will do
- Detailed understanding of all technical primary and secondary billing rules to include, policies and procedures for assigned third party payers and contracts.
- Reads and comprehends correspondence from government and third-party payors to keep abreast of new regulations, policies and billing and payment requirements.
- Consistently and accurately documents accounts with activities as needed in a timely manner.
- Researches and accurately resolves unpaid insurance account (primary and secondary).
- Analyzes and resolves insurance correspondence for unpaid claims.
- Thoroughly researches and resolves identified payment discrepancies in a timely manner including identifying and correct posting errors (i.e. money applied to wrong account or not posted correctly to account).
- Demonstrates a good working knowledge of all applicable processes within the PFS Department.
- Ensures necessary data, identified processing issues and related information is provided to departmental management, appropriate departments and individuals within the organization in a timely manner.
- Exhibits a professional and pleasant demeanor when dealing with patients, employees, third-party payers and other customers of the organization.
- Identifies and notifies management of customer service issues and potential process/system problems that cause billing and payment errors and assists in improvement implementation as requested.
- Identifies and recommends computer system enhancements, computer applications and procedural changes to improve (1) accuracy and timing of claim submissions; (2) accuracy of third party payer and patient payments; (3) customer relations, and (4) efficiency of operations.
- Reads and comprehends correspondence from government and third-party payers to keep abreast of new regulations, policies and billing and payment requirements.
- Answers questions from other staff or clinic offices by phone or e-mail in a timely manner.
- Attends internal and external seminars for personal growth and development and shares pertinent information with other team members.
- Assists with the revision or development of the department's internal documents, procedural manuals and forms, as requested.
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
- Grasping (Fine Motor): Rarely less than 1 hour
- Grasping (Gross Hand): Rarely less than 1 hour
- Handling: Rarely less than 1 hour
- Hearing: Continuously greater than 5 hours
- Repetitive Motions: Continuously greater than 5 hours
- Sitting: Continuously greater than 5 hours
- Standing: Occasionally 1-3 Hours
- Stooping: Rarely less than 1 hour
- Talking: Continuously greater than 5 hours
Working Conditions
- Dusts: Occasionally 1-3 Hours
- Noise/Sounds: Rarely less than 1 hour
- Other Atmospheric Conditions: Rarely less than 1 hour
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.
