Responsible for the provision of complex patient accounting activity to facilitate efficient operations, expeditious reimbursement and optimal customer satisfaction.
The following describes the basic position duties that an employee MUST be able to perform for this role. This information is intended to be descriptive of the key responsibilities of the position. The list of essential functions below DOES NOT identify all duties performed by any single person in the position.
Is skilled in a range of processes, procedures and systems to carry out assigned tasks or has developed deep skills in a single area
Understands the roles of all immediate team members and has a good understanding of how own team integrates with others
Regularly provides guidance and support to more junior team members on challenging problems; helps them balance their workload and apply their skills
Provides solutions to problems in situations that are atypical or occur infrequently based on practice and existing precedents
Impacts the quality, timeliness and effectiveness of the team
Uses discretion to modify work practices and processes (but not policies or procedures) to achieve results or improve efficiency
Clearly and accurately conveys complex information
JOB SPECIFIC RESPONSIBILITIES:
Performs complex billing and collection activity including resolving complex claim edits and denied claims.
Resolves complex patient issues and assists with questions on reimbursement.
Participates and provides significant input for and assistance with the implementation of team-oriented process improvement initiatives.
Provides solutions to problems in situations that are atypical or occur infrequently based on practice and existing precedents.
Possess the ability to interpret and demonstrate compliance with third party contracts, regulations, guidelines, policies and procedures.
Demonstrates "The Children's Way" values and behavioral standards.
Review all assigned accounts to ensure that all information, codes, and other relevant information is correct and charges have been billed within guidelines.
Edit and process claims efficiently, identify errors and/or rejects and resolve billing problems.
Follow-up on all billed claims in a timely manner to ensure accurate, timely payment and disposition of account according to the payer contract or guidelines.
Coordinates and consolidates payer specific reimbursement data to resolve denials and underpayments by payers.
Follow-up with guarantors regarding account status; determine appropriate disposition of the account according to policies and procedures.
Review and resolve credit balance accounts in a timely manner.
Answer questions concerning complex procedures and serve as a resource to collection coordinators as needed, including on-the-job training for one to two processes or systems.
Two to three years of healthcare experience required
Two years of customer service experience required
Knowledge of general procedures and guidelines used by health insurance companies, government agencies, employer benefit departments, and internal departments as they relate to billing and collections. Required
Excellent mathematical skills, computer skills, Microsoft applications and word processing programs skills and minimum of 40 words per minute required
Ability to develop and maintain productive working relationships to fully integrate within a team required
Proficient in English, written and verbal communication skills required
High school diploma or equivalent required
Two-year Associate's degree or equivalent experience required
Specific Knowledge, Skills and Abilities:
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
Develop and use collaborative relationships to facilitate the accomplishment of work goals.
Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
Effectively manage one's time and resources to ensure that work is completed efficiently.
Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
Assimilate and apply new job-related information in a timely manner.
Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.
LICENSES and CERTIFICATIONS:
HFMA Certified Revenue Cycle Representative preferred
Sedentary - Exerting up to 10lbs. occasionally or negligible weights frequently; sitting most of the time.
very highly regarded in the community. I had no idea how many lives Children’s Health had helped until I started wearing my scrubs with our logo on them. I am always getting stopped with compliments about our care.
Speech Language Pathologist