Responsible for effectively billing or rebilling all accounts to the appropriate insurance carrier by implementing billing procedures in a timely manner. Responsible and accountable for pursing collection of all receivables from insurance, guarantor, and/or any other responsible party.

PRINCIPAL DUTIES AND RESPONSIBILITIES(*Essential Functions)

1. Continually follows-up on outstanding accounts through contacts/inquiries to third party payors to facilitate prompt resolution and/or payment and actively pursues payment from patient/guarantor on all outstanding account balances after third party payment or rejection based upon hospital collection guidelines daily.


2. Identifies and investigates delinquent accounts to for special circumstances affecting payment delays and recommends the appropriate disposition.


3. Reviews bad debt prelist report to ensure that adequate follow-up/collection efforts have been performed prior to transferring to the bad debt file weekly.


4. Phones patients to obtain insurance and COB information and inform them of financial responsibility and discusses various payment options.


5. Prepare appropriate billing documents based upon current payor/hospital guidelines for all third party payors.


6. Prepares and processes any necessary adjustment/coding changes on accounts through the system based upon follow-up to expedite the collection process and to ensure the accuracy of the account daily.


7. Review inpatient and outpatient fins to ensure the accuracy and completeness of all documents.


8. Reviews audit discrepancy report, pulls the account, processes the debit/credit adjustments, rebills the account to the third party payor and moves monies back to the insurance load.

JOB SPECIFICATIONS(Minimum Requirements)

KNOWLEDGE, SKILLS, AND ABILITIES

• Knowledge of UB-04 and 1500 billing preferred.
• Must have working knowledge of insurance claim filing, collections, and established refund processing procedures.
• Productivity Standards of 75 accounts a day, miniumum.
• Quality Standards of 95% A/R aging 90 days less than 30% of total A/R.
• Accounts on WQ's can not be aged more than 30 days.
• Mail and correspondence must be worked within 5 working days.
• Medical Records request follow-up must be worked within 7 working days from first request.
• Account rejections in Quadax must be turned around within 2 days of receipt.
• Follow up with UM or physicians office on Prior Authorization denial within 1 day of receipt.
• Bad debt accounts to be worked weekly and completed by month end.
• Resolve and complete patient complaints daily.
• Denial Write-Off rate needs to be <0.5% of net revenue.
• Ability to prioritize job functions, work independently and exercise good judgment.
• Must possess good written/verbal communication skills, good organizational/analytical skill and mathematical aptitude.
• Proficient use of calculator and minimum typing (55 wpm).
• Basic personal computer skills.

EDUCATION

• High School Diploma/GED Equivalent Required
• Associates Business Administration Preferred
• 6 Healthcare/Medical - Business Office Required

STANDARDS OF BEHAVIOR
Meets the Standards of Behavior as outlined in Personnel Policy and Procedure #1, Employee Relations Code.

CONFIDENTIALITY/HIPAA/CORPORATE COMPLIANCE
Demonstrates knowledge of procedures for protecting and maintaining security, confidentiality and integrity of employee, patient, family, organizational and other medical information. Understands and supports the commitment of Methodist Hospitals in adhering to federal, state and local laws, rules and regulations governing ethical business practices for healthcare providers.

DISCLAIMER - The above statements are intended to describe the general nature and level of work being performed by people assigned to this job. The statements are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required.